Get ready: whole blood is back and it's good for patients

Holcomb, John B.; Jenkins, Donald H.

doi:10.1111/trf.14818

Cited by 43 publications

(44 citation statements)

References 24 publications

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“…Current guidelines point to replacing severe blood loss with a balanced transfusion strategy using all three components in a ratio mimicking whole blood functionality . The shift toward using a 1:1:1 blood component therapy has revitalized WB as a viable option in civilian health care . WB offers logistical and hemostatic advantages both in pre‐ and in‐hospital settings where the goal is a perfectly timed balanced transfusion strategy .…”

Section: Identification Of Hemorrhagic Shock and The Indication For Pmentioning

confidence: 99%

“…4 The shift toward using a 1:1:1 blood component therapy has revitalized WB as a viable option in civilian health care. 5,6 WB offers logistical and hemostatic advantages both in pre-and in-hospital settings where the goal is a perfectly timed balanced transfusion strategy. 7 During events of depleted inventory or inadequate surgical hemostasis, both cold-stored WB and freshly drawn WB from a WBB are options.…”

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confidence: 99%

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How do I get an emergency civilian walking blood bank running?

et al. 2019

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The shift toward using a transfusion strategy in a ratio to mimic whole blood (WB) functionality has revitalized WB as a viable option to replace severe blood loss in civilian health care. A military‐civilian collaboration has contributed to the reintroduction of WB at Haukeland University Hospital in Bergen, Norway. WB has logistical and hemostatic advantages in both the pre‐ and in‐hospital settings where the goal is a perfectly timed balanced transfusion strategy. In this paper, we describe an event leading to activation of our emergency WB collection strategy for the first time. We evaluate the feasibility of our civilian walking blood bank (WBB) to cover the need of a massive amount of blood in an emergency situation. The challenges are discussed in relation to the different stages of the event with the recommendations for improvement in practice. We conclude that the use of pre‐screened donors as a WBB in a civilian setting is feasible. The WBB can provide platelet containing blood components for balanced blood resuscitation in a clinically relevant time frame.

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Section: Identification Of Hemorrhagic Shock and The Indication For Pmentioning

confidence: 99%

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confidence: 99%

How do I get an emergency civilian walking blood bank running?

et al. 2019

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“…Whole blood was the resuscitation product of choice until the development of modern blood component separation techniques. 3,4 Compared with component therapy, whole blood offers several potential advantages, including its balanced composition, ease of administration, and longer shelf life compared with thawed plasma and platelets. Recent military experience with fresh whole blood has stimulated renewed interest in its use.…”

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confidence: 99%

Elicitation of prior probability distributions for a proposed Bayesian randomized clinical trial of whole blood for trauma resuscitation

et al. 2020

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BACKGROUND Whole blood trauma resuscitation is conceptually appealing and increasingly used but lacks evidence. A randomized controlled trial is needed but challenging to design. A Bayesian approach might be more efficient and more interpretable than a conventional frequentist design. We report the results on an elicitation meeting to create prior probability distributions to help develop such a trial. METHODS In‐person expert elicitation meeting, based on Sheffield Elicitation Framework methodology. We used an interactive graphical tool to elicit the quantities of interest (24‐hour mortality and certainty required). Two rounds were conducted, with an intervening discussion of deidentified responses. Individual responses were aggregated into probability distributions. RESULTS Fifteen experts participated. The pooled belief was that the median 24‐hour mortality of trauma patients with hemorrhagic shock treated with component therapy (the current standard of care) was 19% (95% credible interval [CrI], 6%‐45%), and the median 24‐hour mortality of those treated with whole blood, 16% (95% CrI, 5%‐39%). The pooled prior distribution for the relative risk had a median of 0.84 (95% CrI, 0.26‐3.1), indicating that the expert group had a 64% prior belief that whole blood decreases 24‐hour mortality compared to component therapy. CONCLUSIONS Experts had moderately strong beliefs that whole blood reduces the 24‐hour mortality of trauma patients with hemorrhagic shock. These data will assist with the design and planning of a Bayesian trial of whole blood resuscitation, which will help to answer a key question in contemporary transfusion practice.

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“…One way to ensure that balanced resuscitation is provided early in the resuscitation effort, whether pre‐ or in‐hospital, is to use whole blood . The use of whole blood as a resuscitation fluid in the pre‐hospital setting was adopted by the US armed forces in Iraq, Syria, and Afghanistan .…”

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confidence: 99%

Early experience with transfusing low titer group O whole blood in the pre‐hospital setting in Israel

et al. 2020

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BACKGROUND The Israeli Defense Force Medical Corps (IDF‐MC) recently implemented the use of low titer group O whole blood (LTOWB) in the airborne combat search and rescue unit (CSAR) for both military and civilian patients during transport to definitive care. LTOWB is preferentially used by the CSAR instead of red blood cell units and freeze‐dried plasma (FDP) for patients with signs of hemorrhagic shock. Ten percent of group O donors were eligible to donate LTOWB as they had anti‐A and ‐B IgM titers of <50. METHODS All patients treated by CSAR providers with LTOWB between July 2018 and June 2019 were included. RESULTS Between July 2018 and June 2019, eight patients have received 10 units of LTOWB. All patients suffered blunt injuries, 6 out of 8 (75%) of whom were due to motor vehicle accidents. Four patients (4 out of 8, 50%) received a single LTOWB unit, two patients (2 out of 8, 25%) received two units. Two pediatric patients received fewer than one unit of LTOWB. Median (range) heart rate was 130 (30‐150) bpm, median systolic blood pressure was 107 (80‐124) mmHg, and median Glasgow coma scale was 8 (on a scale of 3‐15). For four (4 out of 8, 50%) patients, LTOWB was the only blood product used for volume resuscitation. All six adult patients were treated with 1 g of tranexamic acid at the point of injury. CONCLUSIONS The CSAR has successfully implemented a LTOWB program for the pre‐hospital treatment of bleeding patients, and as its experience grows this product will be made available to other units and in civilian hospitals.

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Get ready: whole blood is back and it's good for patients

Cited by 43 publications

References 24 publications

How do I get an emergency civilian walking blood bank running?

How do I get an emergency civilian walking blood bank running?

Elicitation of prior probability distributions for a proposed Bayesian randomized clinical trial of whole blood for trauma resuscitation

Early experience with transfusing low titer group O whole blood in the pre‐hospital setting in Israel

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