An Analysis of the Association of Whole Blood Transfusion With the Development of Acute Respiratory Distress Syndrome

OBJECTIVES: To determine the association of whole blood and other blood products (components, prothrombin complex concentrate, and fibrinogen concentrate) with the development of acute respiratory distress syndrome (ARDS) among blood recipients. DESIGN: Retrospective cohort study. SETTING: American College of Surgeons Trauma Quality Improvement Program (TQIP) database between 2020 and 2021. PATIENTS: Patients 15 years old or older in the TQIP database between 2020 and 2022 who received at least one blood product. INTERVENTIONS: We compared characteristics and blood product administration between patients who developed ARDS versus those who did not. MEASUREMENTS AND MAIN RESULTS: There were 134,863 that met inclusion for this analysis. Within the included population, 1% (1927) was diagnosed with ARDS. The no ARDS group had a lower portion of serious injuries to the head/neck (31% vs. 46%), thorax (51% vs. 78%), abdomen (34% vs. 48%), and extremities (37% vs. 47%). The median composite Injury Severity Score was 21 (11–30) in the no ARDS group vs. 30 (22–41) in the ARDS group. Unadjusted survival of discharge was 74% in the no ARDS group vs. 61% in the ARDS group. In our multivariable model, we found that whole blood (unit odds ratio [uOR], 1.05; 95% CI, 1.02–1.07), male sex (odds ratio, 1.44; 95% CI, 1.28–1.63), arrival shock index (uOR, 1.03; 95% CI, 1.01–1.06), and composite Injury Severity Score (uOR, 1.03; 95% CI, 1.03–1.04) were associated with the development of ARDS. These persisted on sensitivity testing. CONCLUSIONS: We found an association between whole blood and the development of ARDS among trauma patients who received blood transfusions. Contrary to previous studies, we found no association between ARDS and fresh frozen plasma administration. The literature would benefit from further investigation via prospective study designs.