Whole blood has been identified as a critical component in the resuscitation of critically ill trauma patients in the prehospital setting. Studies have demonstrated that the early administration of whole blood in the prehospital phase can significantly benefit trauma patients with hemorrhagic shock (Mapp et al., 2020; Rangrass, 2022; Shackelford et al., 2021). Reputable organizations such as the Joint Trauma System, the Defense Committee on Trauma, and the Armed Services Blood Program have endorsed whole blood as the preferred resuscitation product for treating hemorrhagic shock in trauma patients (Shackelford et al., 2021). It is emphasized that whole blood should be available within 30 minutes from the time of injury to ensure timely intervention (Shackelford et al., 2021).
Research supports that whole blood transfusion in trauma patients with severe hemorrhage leads to better outcomes compared to conventional component therapy (Smith et al., 2021). Additionally, the use of low-titer type O whole blood has shown promise in both prehospital and trauma center resuscitation of bleeding patients (McCoy et al., 2020). The implementation of low-titer whole blood transfusion programs in civilian settings has demonstrated improved survival rates for trauma patients (Sunde et al., 2022).
Recent conflicts have challenged the conventional practice of not using whole blood transfusions as the standard of care, highlighting the potential superiority of whole blood in transfusion therapy for adult trauma patients (Kronstedt et al., 2022). Studies have also indicated that fresh whole blood transfusions by forward surgical teams have contributed to improved survival rates in critically injured combat casualties (Gurney et al., 2020).
In conclusion, evidence from various studies supports the use of whole blood as the preferred resuscitation fluid for critically ill trauma patients in the prehospital setting. The early administration of whole blood has been associated with improved outcomes, including better shock severity, coagulopathy management, and overall survival rates in trauma patients with hemorrhagic shock.
References:
- Gurney, J., Staudt, A., Cap, A., Shackelford, S., Mann-Salinas, E., Le, T., … & Spinella, P. (2020). Improved survival in critically injured combat casualties treated with fresh whole blood by forward surgical teams in afghanistan. Transfusion, 60(S3).
https://doi.org/10.1111/trf.15767
- Kronstedt, S., Lee, J., Millner, D., Mattivi, C., LaFrankie, H., Paladino, L., … & Siegler, J. (2022). The role of whole blood transfusions in civilian trauma: a review of literature in military and civilian trauma. Cureus.
https://doi.org/10.7759/cureus.24263
- Mapp, J., Manifold, C., Garcia, A., Aguilar, J., Stringfellow, M., & Winckler, C. (2020). Prehospital blunt traumatic arrest resuscitation augmented by whole blood: a case report. Transfusion, 60(5), 1104-1107.
https://doi.org/10.1111/trf.15740
- McCoy, C., Brenner, M., Duchesne, J., Roberts, D., Ferrada, P., Hörer, T., … & Cotton, B. (2020). Back to the future: whole blood resuscitation of the severely injured trauma patient. Shock, 56(1S), 9-15.
https://doi.org/10.1097/shk.0000000000001685
- Rangrass, G. (2022). Whole blood use in trauma resuscitation: targeting prehospital transfusion. Current Opinion in Anaesthesiology, 35(2), 146-149.
https://doi.org/10.1097/aco.0000000000001099
- Shackelford, S., Gurney, J., Taylor, A., Keenan, S., Corley, J., Cunningham, C., … & Program, A. (2021). Joint trauma system, defense committee on trauma, and armed services blood program consensus statement on whole blood. Transfusion, 61(S1).
https://doi.org/10.1111/trf.16454
- Smith, A., Alkhateb, R., Braverman, M., Shahan, C., Axtman, B., Nicholson, S., … & Jenkins, D. (2021). Efficacy and safety of whole blood transfusion in non-trauma patients. The American Surgeon, 89(11), 4934-4936.
https://doi.org/10.1177/00031348211048831
- Sunde, G., Bjerkvig, C., Bekkevold, M., Kristoffersen, E., Strandenes, G., Bruserud, Ø., … & Heltne, J. (2022). Implementation of a low-titre whole blood transfusion program in a civilian helicopter emergency medical service. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 30(1).
https://doi.org/10.1186/s13049-022-01051-z