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Semin Thromb Hemost 2020; 46(02): 221-234
DOI: 10.1055/s-0040-1702174
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Whole Blood for Civilian Urban Trauma Resuscitation: Historical, Present, and Future Considerations

Mark Walsh
1   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
2   Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
3   Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana
,
Dietmar Fries
4   Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
,
Ernest Moore
5   Ernest E. Moore Trauma Center, Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado
,
Hunter Moore
5   Ernest E. Moore Trauma Center, Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado
,
Scott Thomas
3   Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana
,
Hau C. Kwaan
6   Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Mathew K. Marsee
7   Indiana University School of Medicine, South Bend, Indiana
,
Anne Grisoli
7   Indiana University School of Medicine, South Bend, Indiana
,
Ross McCauley
7   Indiana University School of Medicine, South Bend, Indiana
,
Stefani Vande Lune
7   Indiana University School of Medicine, South Bend, Indiana
,
Swetha Chitta
3   Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana
,
Sudhir Vyakaranam
1   Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
2   Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Dan Waxman
8   Versiti Blood Center of Indiana, Indianapolis, Indiana
,
Michael T. McCurdy
9   Department of Critical Care and Emergency Medicine, University of Maryland, Baltimore, Maryland
,
Donald Zimmer
3   Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana
,
Bhavesh Patel
10   Department of Critical Care Medicine, Mayo Clinic Phoenix, Arizona
,
Jecko Thachil
11   Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
11 March 2020 (online)

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Abstract

Whole blood (WB) has been used for more than a century for far-forward combat resuscitation. Following the Iraq/Afghanistan combat, maritime, and austere environment use of WB for the resuscitation of severely hemorrhaging patients, there has been an increasing use of WB for the civilian urban resuscitation environment population. The impetus for this was not just improved outcomes in far-forward hospitals, which had different populations and different needs than the civilian urban population, but also an application of the lessons suggested by recent 1:1:1 plasma:platelets:packed red cells fixed-ratio studies for patients with massive transfusion needs. Mechanistic, logistic, and standardization concerns have been addressed and are evolving as the WB project advances. A small number of studies have been published on WB in the civilian urban trauma population. In addition, European experience with viscoelastic testing and resuscitation with fibrinogen and prothrombin complex concentrate has provided another viewpoint regarding the choice of resuscitation strategies for severely bleeding trauma patients in urban civilian environments. There are randomized controlled trials in process, which are testing the hypothesis that WB may be beneficial for the civilian urban population. Whether WB will improve mortality significantly is now a matter of intense study, and this commentary reviews the history, mechanistic foundations, and logistical aspects for the use of WB in the civilian trauma population.

Keywords

whole blood - cold-stored whole blood - fixed ratios - fibrinogen concentrate therapy - prothrombin complex concentrate therapy - combat - civilian
 

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