在农村创伤系统中实施全血试点项目：可行性、利用与成本分析
本研究为前瞻性单中心试点研究，2023年4月至2024年3月在农村一级创伤中心开展院前LTOWB项目，每周向直升机急救医疗服务部署1单位LTOWB，未使用的在采集后第14天转为浓缩红细胞。55周共部署55单位，45.5%作为LTOWB使用（27.3%院前，18.2%院内），47.3%转为PRBC，仅7.2%浪费或过期。月均浪费成本1576.79美元 vs 历史1493.89美元（P=0.692），院前LTOWB可用性维持84.2%天数。结论认为该模式可行且成本中性，支持在资源有限环境扩展全血项目。
要点
- 55周部署55单位LTOWB，45.5%作为LTOWB使用（27.3%院前、18.2%院内），47.3%第14天转为PRBC。
- 仅4单位（7.2%）浪费或过期；月均浪费成本1576.79美元 vs 历史1493.89美元（P=0.692），成本中性。
- 尽管供应受限，院前LTOWB可用性仍维持84.2%的研究天数。
- 每周向直升机EMS部署1单位LTOWB，未使用者在采集后第14天转为PRBC以减少浪费。
- 证据等级为经济/价值评估Level III，单中心前瞻性试点，需进一步验证患者结局影响。
适用人群与场景
- 农村一级创伤中心院前直升机急救医疗服务场景，疑似出血创伤患者（原文未列具体纳入/排除标准）。
诊断标准与关键阈值
- 原文未提及
处置流程与药物剂量
- 每周向直升机EMS部署1单位LTOWB；未使用的LTOWB在采集后第14天转为浓缩红细胞以减少浪费。
红旗征与不能漏的情况
- 原文未提及
研究设计与关键结果
- 前瞻性单中心试点研究，55周部署55单位LTOWB，45.5%作为LTOWB使用（27.3%院前，18.2%院内），47.3%转为PRBC，7.2%浪费或过期；月均浪费成本1576.79美元 vs 历史1493.89美元（P=0.692）；院前可用性84.2%天数。
证据类型、等级与局限
- 经济/价值评估，Level III；单中心、前瞻性试点、样本量小（55单位）、历史对照。
对床旁实践的改变
- 支持在农村创伤系统开展院前LTOWB项目，采用第14天未用转PRBC的结构化流程可维持高利用、低浪费且成本中性；不改变具体输血阈值或剂量（原文未提供）。
指南或共识出处
- 原文未提及
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英文原文（摘要）· 点击展开
BACKGROUND: Hemorrhage is a leading cause of preventable trauma death, particularly in rural settings where prolonged transport times delay resuscitation. Low-titer O + whole blood (LTOWB) is increasingly favored for prehospital resuscitation due to its combined oxygen-carrying and hemostatic properties. However, logistical challenges and concerns regarding waste and cost have limited its implementation in rural trauma systems. This study evaluates the feasibility and clinical utility of a prehospital LTOWB pilot program at a rural Level I trauma center.
METHODS: We conducted a prospective, single-center pilot study from April 2023 to March 2024, comparing LTOWB data to historical component therapy from the prior year. One unit of LTOWB was deployed weekly to the Helicopter Emergency Medical Services. To mitigate waste, unutilized LTOWB was converted to packed red blood cells on Day 14 post collection. Data on utilization, waste, cost, and availability were collected and analyzed.
RESULTS: During the 55-week period, 55 units of LTOWB were deployed, of which 45.5% were used as LTOWB (27.3% prehospital, 18.2% in-hospital) and 47.3% as processed packed red blood cells. Only four units (7.2%) were lost to waste or expiration. The average monthly waste cost was $1,576.79 during the study versus $1,493.89 historically ( p = 0.692). Despite supply limitations, prehospital LTOWB availability was maintained for 84.2% of the study days.
CONCLUSIONS: Implementing a prehospital LTOWB pilot program in a rural trauma system is feasible and cost-neutral. A structured processing protocol achieves high utilization while minimizing waste. These findings support the expansion of whole blood programs to enhance early resuscitation and potentially improve patient outcomes in resource-limited environments.
LEVEL OF EVIDENCE: Economic/Value-based Evaluations, Level III.
参考来源
- Saeg F, Berry CL, Tubby B, et al. Implementing a whole blood pilot program in a rural trauma system: A feasibility, utilization, and cost analysis. J Trauma Acute Care Surg. 2026. PMID: 42425697. doi:10.1097/TA.0000000000005019
供执业医师抢救与诊疗参考，不替代临床判断；剂量请结合体重、肝肾功能和本院药品规格复核，以指南原文为准。