Purpose: The coronavirus (COVID-19) pandemic has caused major healthcare challenges worldwide resulting in an exponential increase in the need for hospital- and intensive care support for COVID-19 patients. As a result, surgical care was restricted to urgent cases of surgery. However, the care for trauma patients is not suitable for reduction or delayed treatment. The influence of the pandemic on the burden of disease of trauma care remains to be elucidated.Methods: All patients with traumatic injuries that were presented to the emergency departments (ED) of the Amsterdam University Medical Center, Location Academic Medical Center (AMC) and VU medical center (VUMC) and the Northwest Clinics (NWC) between March 10, 2019 and May 10, 2019 (non-COVID) and March 10, 2020 and May 10, 2020 (COVID-19 period) were included. The primary outcome was the difference in ED admissions for trauma patients between the non-COVID and COVID-19 study period. Additionally, patient- and injury characteristics, health care consumption, and 30-day mortality were evaluated.Results: A 37% reduction of ED admissions for trauma patients was seen during the COVID-19 pandemic (non-COVID n = 2423 and COVID cohort n = 1531). Hospital admission was reduced by 1.6 trauma patients per day. Fewer patients sustained car- and sports-related injuries. Injuries after high energetic trauma were more severe in the COVID-19 period (Injury Severity Score 17.3 vs. 12.0, p = 0.006). Relatively more patients were treated operatively (21.4% vs. 16.6%, p < 0.001) during the COVID-19 period. Upper-(17.6 vs. 12.5%, p = 0.002) and lower extremity injuries (30.7 vs. 23.0%, p = 0.002) mainly accounted for this difference. The 30-day mortality rate was higher during the pandemic (1.0 vs. 2.3%, p = 0.001).Conclusion: The burden of disease and healthcare consumption of trauma patients remained high during the COVID-19 pandemic. Results of this study can be used to optimize the use of hospital capacity and anticipate health care planning in future outbreaks.

The objective of this study was to determine whether there is an association between sex and outcome in trauma patients presented with severe traumatic brain injury (TBI). A retrospective multicenter study was performed in trauma patients aged ≥ 16 years who presented with severe TBI (Head Abbreviated Injury Scale (AIS) ≥ 4) over a 4-year-period. Subgroup analyses were performed for ages 16–44 and ≥45 years. Also, patients with isolated severe TBI (other AIS ≤ 2) were assessed, likewise, with subgroup analysis for age. Sex differences in mortality, Glasgow Outcome Score (GOS), ICU admission/length of stay (LOS), hospital LOS, and mechanical ventilation (MV) were examined. A total of 1566 severe TBI patients were included (831 patients with isolated TBI). Crude analysis shows an association between female sex and lower ICU admission rates, shorter ICU/hospital LOS, and less frequent and shorter MV in severe TBI patients ≥ 45 years. After adjusting, female sex appears to be associated with shorter ICU/hospital LOS. Sex differences in mortality and GOS were not found. In conclusion, this study found sex differences in patient outcomes following severe TBI, potentially favoring (older) females, which appear to indicate shorter ICU/hospital LOS (adjusted analysis). Large prospective studies are warranted to help unravel sex differences in outcomes after severe TBI.

Objective: There is a lack of comprehensive international data regarding platelet transfusion practices in the ICU. This study aimed to evaluate the current occurrence rate of platelet transfusion in the ICU and provide an overview of platelet transfusion practices including indications for a platelet transfusion, thresholds, (non-)adherence and geo-economic region variations. Design: International prospective cohort study. Setting: Two hundred thirty-three centers in 30 countries worldwide. Patients: All patients 18 years old and older, admitted to the ICU during a single study week, selected by each site from one of the 16 predefined weeks (March 2019 to October 2022), were included. Interventions: None. Measurements and Main Results: Of the 3643 patients, 208 (6%) received a platelet transfusion during their ICU stay and main indications consisted of active bleeding (42%, n = 187/443), prophylaxis (33%, n = 144/443) or an upcoming procedure (12%, n = 51/443). The median platelet count before transfusion was 44 × 10 ⁹ /L (interquartile range [IQR], 20–78) with variation by indication, including a higher median of 60 × 10 ⁹ /L (IQR 31–93) during active bleeding. A threshold for transfusion was stated in 51% ( n = 224/443) of the events, with a median threshold platelet count of 50 × 10 ⁹ /L (IQR, 40–100). The advised threshold was not adhered to in 16% ( n = 36/224) of cases, with the majority having active bleeding as indication. Contrasts in transfusion practices were observed across different geo-economic regions. Platelet transfusions were administered to 6% ( n = 156/2520) of patients in high-income countries, 5% ( n = 52/1069) of patients in upper-middle-income countries and in none from lower-middle-income countries ( n = 0/54). Non-adherence was higher in the high-income countries (23%, n = 34/149) than upper-middle-income countries (3%, n = 2/75). Conclusions: Platelet transfusions were administered to a small proportion of critically ill patients, and were given to treat active bleeding or as prophylaxis in the majority of cases. Occurence rate, indication and threshold adherence for platelet transfusion widely varied between geo-economic regions.

Labeling of platelets (PLTs) is essential for research purposes, in order to measure the recovery and survival of transfused PLTs in vivo. Biotinylation is a promising new alternative to the gold standard of radioactive labeling. This review highlights 4 key publications that provide significant insights into biotin-labeled PLTs (bioPLTs). Stohlawetz et al. established that transfusion of bioPLTs in human recipients is possible. De Bruin et al. developed a standardized, reproducible protocol for biotinylation of PLTs as a promising method to trace and isolate transfused PLTs in vivo, with reduced levels of PLT activation markers. Muret et al. developed a nonwashing biotin labeling method to implement in a blood bank environment. Finally, in a preclinical study, Ravanat et al. showed that different densities of biotin can be used to concurrently monitor multiple populations of human PLTs in the circulation of the same subject. These studies have made major contributions to the development of bioPLTs as a viable option for use in human research, and indicate that bioPLTs can be safely administered, preferably at a low density of biotin.

For decades, di(2-ethylhexyl) phthalate (DEHP) has been the primary plasticizer used to make polyvinyl chloride (PVC) blood bags flexible. DEHP leaches into the blood product, stabilizing red blood cell (RBC) membranes and preventing excessive hemolysis. Despite being classified as a substance of very high concern due to its potential endocrine-disrupting and carcinogenic effects, DEHP has continued to be used in red cell concentrate (RCC) storage bags, as alternatives have often led to reduced RCC quality during storage. However, under the European Medical Device Regulation the use of DEHP in medical devices is restricted to below 0.1% by weight per July 2030. As a result, the effect of several alternative plasticizers on RCC quality, such as di(2-ethylhexyl) terephthalate (DEHT), 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH), and N-butyryl-n-hexyl citrate (BTHC), have recently been investigated in combination with different storage solutions. Although previous studies using these new combinations showed variable results, these alternatives remain the most promising options, with current data demonstrating reduced leaching and lower toxicity compared to DEHP. This review highlights key publications on the transition from DEHP-PVC blood bag systems for RCC storage, demonstrating that several non-DEHP alternatives are viable replacement options, particularly when combined with next-generation storage solutions. Future studies are required to assess the frequency of adverse events, the occurrence of handling issues such as leakage, and to evaluate practical performance and clinical efficacy through post-transfusion recovery and increment studies.

Background: The objective of this study was to determine the association between sex and outcome among severely injured patients who were admitted in severe shock. Methods: A retrospective multicenter study was performed in trauma patients (Injury Severity Score (ISS) ≥ 16) aged ≥ 16 presenting with severe shock (Shock Index > 1.3) over a 4-year period. To determine if sex was associated with mortality, Intensive Care Unit (ICU) admission, mechanical ventilation, blood transfusion and in-hospital complications, multivariable logistic regressions were performed. Results: In total, 189 patients were admitted to the Emergency Department in severe shock. Multivariable logistic regression analysis showed that female sex was independently associated with a decreased likelihood of acute kidney injury (OR 0.184; 95% CI 0.041–0.823; p = 0.041) compared to the male sex. A significant association between female sex and mortality, ICU admission, mechanical ventilation, other complications and packed red blood cells transfusion after admission could not be confirmed. Conclusion: Female trauma patients in severe shock were significantly less likely to develop AKI during hospital stay. These results could suggest that female trauma patients may manifest a better-preserved physiologic response to severe shock when compared to their male counterparts. Prospective studies with a larger study population are warranted.