Declaration of Futility in Severely Injured Patients: Results of a Nationwide Survey to Blood Bankers
Recommended Citation
Bunch CM, Johnson J, Lopez-Plaza I, Brancamp R, Haidar S, Kwaan H, Miller JB, Zhao J, Waxman D, Rajbhandary S, Carayiannis S, Hartwell E, Gorlin J, Hemerlin D, Añón S, Ranginwala A, Qasim Z, Ludwig R, Al-Fadhl H, Walsh M. Declaration of Futility in Severely Injured Patients: Results of a Nationwide Survey to Blood Bankers. Acad Emerg Med 2025; 32(S1):282-283.
Document Type
Conference Proceeding
Publication Date
5-13-2025
Publication Title
Acad Emerg Med
Keywords
aged, bleeding, blood bank, blood transfusion, clinical practice guideline, conference abstract, controlled study, emergency ward, female, human, multiple trauma, prognosis, resuscitation, retrospective study, therapy
Abstract
Background and Objectives: The unintended consequence of balanced hemostatic resuscitation with the increased use of 1:1:1 blood product with whole blood resuscitation for bleeding trauma patients is an exacerbation of the already dwindling national blood supply. To date, there are no agreed upon guidelines which determine futility for patients who have received massive transfusion and who have consumed large quantities of blood products without response. Recent attempts using clinical, laboratory, viscoelastic, and transfusion cut points have attempted to define those patients unlikely to survive resuscitation for severe bleeding caused by trauma. Methods: The AABB petitioned 834 AABB accredited blood banks and hospital transfusion services in October of 2024, of which 213 centers responded to a 21-point survey concerning futile resuscitation for severely bleeding trauma patients. Results: Among the 213 centers that responded, 10.3% limited the availability of blood products to patients outside of the trauma setting due to high use of blood transfusions in massive trauma resuscitation efforts. Of these institutions, 27.3% have a resuscitation protocol with a consideration for futility to guide suspension of blood product administration during massive trauma resuscitation. Of the institutions that did not need to limit the availability of blood products to patients outside of the trauma setting due to high use of blood transfusions in massive trauma resuscitation efforts, only 8.4% have a resuscitation protocol with a consideration for futility to guide suspension of blood product administration during massive trauma resuscitation. Of institutions that do not have a futility protocol currently, only 11.9% plan to develop or implement a futility protocol in the near future. Conclusion: Of 834 AABB certified blood centers, 213 responded to a 21-point survey concerning futile resuscitation for severely bleeding trauma patients. In spite of the well-recognized nationwide shortage of blood products during peak periods of trauma presenting to emergency departments, there is little consensus regarding establishing reliable guidelines for defining futility for severely bleeding trauma patients who have not responded to aggressive hemostatic resuscitation and who's prognosis is bleak.
Volume
32
Issue
S1
First Page
282
Last Page
283
