The Dead Sea needs salt water… massively bleeding patients need whole blood: The evolution of blood product resuscitation

The Evolution of Blood Transfusion in the Trauma Patient: Whole Blood Has Come Full Circle

“…61 Potential barriers aside, we believe that even now there are enough data to move forward with whole blood resuscitation in trauma patients. From the ease of use in delivering all necessary blood components in a single bag 72 to the ability to get platelets and plasma to more rural areas that currently lack access, 4,72 with recent data showing that patients resuscitated with whole blood do at least as well as patients resuscitated with component therapy alone, 73 we believe that the advantages of whole blood make it the superior blood product for hemorrhaging patients.…”

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

“…38 These examples have been cited as rationale for the recent provision of CSWB to urban civilian hospitals and trauma systems in the United States. 2,31,32,[38][39][40][41][42] The THOR group has proposed additional studies of CSWB in the civilian arena. 38 Although the first comparative study of WB versus standard component therapy was proposed for civilian trauma resuscitation in 2009, 1 there are only a few retrospective comparative studies of CSWB with fixed ratio or standard resuscitation for urban civilian populations and only one randomized controlled trial (RCT) (►Table 2).…”

“…The other published papers concerning the civilian use of WB for 12,28,[35][36][37] trauma are either editorials or descriptive papers on the feasibility and applicability of military far-forward WB use for trauma resuscitation generally. [3][4][5][6][7][30][31][32][40][41][42][43][44] These data-from a combined total of only 586 civilian patients-form the basis of recent widespread adoption of WB use in the United States prehospital and hospital environments in urban areas, with short transport times. 1,7,15,30,31,40,41,44,45,49,50 For this reason, it is beneficial to review the mechanistic rationale of using WB in the urban civilian environment.…”

“…Therefore, there is reason to further study prehospital and early hospital use of WB for trauma resuscitation. 2,15,30,31,92 Although civilian trauma patient populations differ substantially from combat casualty patients-when comparing transport times, average age, comorbidities, and mechanism of injuries-there has still been swift adoption of CSWB in the prehospital and hospital urban environments in the United States. As seen in military settings and literature, the beneficial effect of immediate resuscitation of the select group of patients with severe hemorrhagic shock is considered as a justification for providing WB within minutes of presentation, whether military or civilian.…”

“…Current studies on WB in trauma resuscitation in the civilian urban environment predominantly use CSWB. 5,8,30,31 WB that is tested for transfusion-transmitted infections (TTIs) has been approved for use in the United States by the U.S. Food and Drug Administration (FDA) for massive blood loss. A report of 10,000 fresh WB transfusions confirmed one case of hepatitis C virus, one case of human T-lymphotropic virus seroconversion, and one death from transfusion-associated graft-versus-host disease; there is also an increased risk of administration of ABO-mismatched blood.…”