A whole blood based resuscitation strategy in civilian medical services: Experience from a Norwegian hospital in the period 2017–2020

Abstract

Background Civilian and military guidelines recommend early balanced transfusion to patients with life‐threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use. Study design and methods Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post‐transfusion blood samples were collected to analyze isohemagglutinin (anti‐A/‐B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff. Results Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7 units (range 1–35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non‐group O. Haptoglobin level was lower in the transfusion episodes for non‐O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion‐associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion. Discussion The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in‐hospital treatment of bleeding.

Implementation of a dual platelet inventory in a tertiary hospital during the COVID‐19 pandemic enabling cold‐stored apheresis platelets for treatment of actively bleeding patients

“…In Norway, CSP has been transfused as cold‐stored whole blood since 2015, when we started using low titer group O whole blood in the air ambulance service based in Bergen 14 . In 2017 we implemented whole blood stored for up to 21 days for bleeding patients at Haukeland University Hospital 15 . In 2015 the U.S. Food and Drug Administration approved CSP from apheresis stored unagitated for up to three days for use to actively bleeding patients 16 .…”

“… 14 In 2017 we implemented whole blood stored for up to 21 days for bleeding patients at Haukeland University Hospital. 15 In 2015 the U.S. Food and Drug Administration approved CSP from apheresis stored unagitated for up to three days for use to actively bleeding patients. 16 In 2021 they expanded the allowed storage time to 14 days.…”

The Norwegian blood preparedness project: A whole blood program including civilian walking blood banks for early treatment of patients with life‐threatening bleeding in municipal health care services, ambulance services, and rural hospitals

“…The use of walking blood banks is not restricted to patients with bleeding due to trauma, but can be used for all causes of bleeding that require a balanced transfusion. Walking blood banks have been used with success in military medical services, for cruise liners, and in civilian hospital emergency preparedness plans in case of depletion of inventories 5,13,16–18,20–24 . In Norway, preplanned civilian walking blood banks have been established for the oil industry to be used in operations with long evacuation time.…”

“…[9][10][11][12][13][14] Today, LTOWB is implemented in routine use for civilian and military prehospital air ambulance services, in a large trauma center, and in four local hospitals in Norway. 13,15,[16][17][18] We have previously described our experience with whole blood based blood preparedness programs for a level 1 trauma hospital and for small rural hospitals with limited blood inventories. 16,18 However, bad weather conditions and long transport distances, especially in the Northern part of Norway, may limit access to emergency health care support and delay medical evacuation.…”

“…Walking blood banks have been used with success in military medical services, for cruise liners, and in civilian hospital emergency preparedness plans in case of depletion of inventories. 5,13,[16][17][18][20][21][22][23][24] In Norway, preplanned civilian walking blood banks have been established for the oil industry to be used in operations with long evacuation time. In case of bleeding, health care personnel on site are trained to collect and transfuse WB from prescreened fellow workers.…”