Evidence map›Paper›PMID 34869909›Full record

ArticleTrauma surgery & acute care open2021

Is the whole greater than the sum of its parts? The implementation and outcomes of a whole blood program in Ecuador.

Amber Himmler, Monica Eulalia Galarza Armijos, Jeovanni Reinoso Naranjo, Sandra Gioconda Peña Patiño, Doris Sarmiento Altamirano, Nube Flores Lazo, Raul Pino Andrade, Hernán Sacoto Aguilar, Lenin Fernández de Córdova, Cecibel Cevallos Augurto and 3 more

Open access · goldAbstract read
In one paragraph

Article in Trauma surgery & acute care open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.1field-weighted citation impact, top 54% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 7 institutions in 2 countries.

Amber HimmlerDepartment of Surgery, MedStar Georgetown University Hospital, Washington DC, District of Columbia, USA.ORCID 0000-0001-7180-5787
Monica Eulalia Galarza ArmijosDepartment of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.
Jeovanni Reinoso NaranjoDepartment of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.
Sandra Gioconda Peña PatiñoCollege of Medicine, Universidad de Cuenca, Cuenca, Ecuador.
Doris Sarmiento AltamiranoCollege of Medicine, University of Azuay, Cuenca, Ecuador.
Nube Flores LazoDepartment of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.
Raul Pino AndradeDepartment of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.
Hernán Sacoto AguilarDepartment of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.ORCID 0000-0002-1144-9757
Lenin Fernández de CórdovaDepartment of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.
Cecibel Cevallos AugurtoDepartment of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.
Nakul RaykarDepartment of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Juan Carlos PuyanaDepartment of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Juan Carlos SalameaDepartment of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.
University of Cuenca · ECHospital Vicente Corral Moscoso · ECBrigham and Women's Hospital · USGeorgetown University · USUniversidad Católica de Cuenca · ECUniversidad del Azuay · ECUniversity of Pittsburgh · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHemorrhagic shock is a major cause of mortality in low-income and middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood (WB) program in Latin America and to discuss the outcomes of the patients who received WB.

methodsWe conducted a retrospective review of patients resuscitated with WB from 2013 to 2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, shock index, Revised Trauma Score in trauma patients, intraoperative crystalloid (lactated Ringer's or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length of stay, and in-hospital mortality.

resultsThe sample includes a total of 101 patients, 57 of which were trauma and acute care surgery patients and 44 of which were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. The average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of WB. Overall mortality was 13.86% (14 of 101) in the first 24 hours and 5.94% (6 of 101) after 24 hours. DISCUSSION: Implementing a WB protocol is achievable in LMICs. WB allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a WB program implemented in a civilian hospital in Latin America. LEVEL OF EVIDENCE: Level IV.

Indexed as

global surgeryhemorrhageshockwhole blood

Identifiers

PMID34869909
PMCPMC8603278
OpenAlexW3155078810

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.