The impact of LTOWB vs. standard component therapy on Transfusion-related complications in trauma resuscitation: a systematic review and meta-analysis

Background: Haemorrhage secondary to trauma is the leading cause of preventable fatalities. Low Titre O Whole Blood (LTOWB) has been reintroduced as a potential alternative to component therapy (CT) in trauma resuscitation due to its balanced composition. This systematic review and meta-analysis compares the incidence of transfusion related complications, including pulmonary embolism (PE), deep vein thrombosis (DVT), acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS), in trauma patients receiving LTOWB versus CT. Methods: A search of PubMed, Scopus, Embase and Web of Science databases was conducted to identify studies reporting adverse outcomes in adult civilian trauma patients receiving LTOWB or CT. Eligible studies were assessed for quality using the STROBE checklist. Meta-analyses were performed using RevMan software (Version 8.5.2, The Cochrane Collaboration, UK) to calculate pooled odds ratios (ORs) with 95% confidence intervals (CI) for PE, DVT, AKI, and ARDS. Results: Ten studies met the inclusion criteria. No statistically significant differences were observed between LTOWB and CT groups for PE (OR 1.17, 95% CI 0.73-1.89, P = 0.51), DVT (OR 0.83, 95% CI 0.47-1.45, P = 0.51), AKI (OR 1.37, 95% CI 0.77-2.44, P = 0.28), or ARDS (OR 1.35, 95% CI 0.84-2.17, P = 0.21). Moderate heterogeneity was observed for some outcomes. Conclusion: LTOWB offers a viable alternative to CT in trauma resuscitation without increasing the risk of transfusion related adverse outcomes. Further randomised controlled trials with standardised criteria are required to confirm LTOWB's safety and its role in reducing adverse outcomes.<p></p>