Whole Blood in Trauma: A Review for Emergency Clinicians

Weymouth, Wells; Long, Brit; Koyfman, Alex; Winckler, C

doi:10.1016/j.jemermed.2019.01.024

Cited by 32 publications

(23 citation statements)

References 47 publications

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“…Clinical guidelines advocate hemorrhage control and early blood‐based resuscitation of severely injured casualties 3,4 . Some authors now advocate early use of whole blood (WB) 5,6 . The change in clinical practice challenges logistics of blood supply, especially for remote healthcare.…”

Section: Introductionmentioning

confidence: 99%

Effect of parachute delivery on red blood cell (RBC) and plasma quality measures of blood for transfusion

et al. 2021

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Background Parachute airdrop offers a rapid transfusion supply option for humanitarian aid and military support. However, its impact on longer‐term RBC survival is undocumented. This study aimed to determine post‐drop quality of RBCs in concentrates (RCC), and both RBCs and plasma in whole blood (WB) during subsequent storage. Study design and methods Twenty‐two units of leucodepleted RCC in saline, adenine, glucose, mannitol (SAGM) and 22 units of nonclinical issue WB were randomly allocated for air transportation, parachute drop, and subsequent storage (parachute), or simply storage under identical conventional conditions (4 ± 2°C) (control). All blood products were 6–8 days post‐donation. Parachute units were packed into Credo Cubes, (Series 4, 16 L) inside a PeliCase (Peli 0350) and rigged as parachute delivery packs. Packs underwent a 4‐h tactical flight (C130 aircraft), then parachuted from 250 to 400 ft before ground recovery. The units were sampled aseptically before and after airdrop at weekly intervals. A range of assays quantified the RBC storage lesion and coagulation parameters. Results Blood units were maintained at 2–6°C and recovered intact after recorded ground impacts of 341–1038 m s−2. All units showed a classical RBC storage lesion and increased RBC microparticles during 42 days of storage. Fibrinogen and clotting factors decreased in WB during storage. Nevertheless, no significant difference was observed between Control and Parachute groups. Air transportation and parachute delivery onto land did not adversely affect, or shorten, the shelf life of fresh RBCs or WB. Discussion Appropriately packaged aerial delivery by parachute can be successfully used for blood supply.

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Section: Introductionmentioning

confidence: 99%

Effect of parachute delivery on red blood cell (RBC) and plasma quality measures of blood for transfusion

et al. 2021

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“…2 National and international guidelines, both civilian and military, recommend early balanced transfusion in life-threatening bleeding to restore oxygen delivery, maintain blood volume, and support hemostasis. [3][4][5][6][7] The ability to provide platelets, plasma, and RBCs early improves survival outcomes, but is logistically challenging in prehospital settings and for smaller hospitals with limited blood inventories. [8][9][10][11] The optimal choice of resuscitation fluid for this patient category is still under debate, with the controversy of whether a blood component-based strategy or a whole blood-based strategy should be preferred.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11] The optimal choice of resuscitation fluid for this patient category is still under debate, with the controversy of whether a blood component-based strategy or a whole blood-based strategy should be preferred. 12 Whole blood affords plasma, RBCs, and platelets in a balanced ratio, 6,7,12,13 and has been implemented in a significant number of trauma centers worldwide. [14][15][16] Transfusion of whole blood has certain major advantages compared with blood components.…”

Section: Introductionmentioning

confidence: 99%

“…Over the past decades, significant changes in the resuscitation approach for uncontrolled bleeding and hemorrhagic shock have evolved 2 . National and international guidelines, both civilian and military, recommend early balanced transfusion in life‐threatening bleeding to restore oxygen delivery, maintain blood volume, and support hemostasis 3–7 . The ability to provide platelets, plasma, and RBCs early improves survival outcomes, but is logistically challenging in prehospital settings and for smaller hospitals with limited blood inventories 8–11 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…Since trauma patients requiring hemostatic resuscitation usually experience a massive loss of intravascular volume, the administration of FFP in su cient doses without cryoprecipitate might be enough to replace the loss of clotting factors [15]. In the present study, we aimed to evaluate whether early use of cryoprecipitate in addition to FFP during the resuscitation of bleeding trauma patients has a bene cial effect on outcomes compared to FFP only, taking into account the total amount of clotting factors given by FFP and cryoprecipitate.…”

Section: Introductionmentioning

confidence: 99%

Clinical Benefits of Early Concurrent use of Cryoprecipitate and Plasma Compared with Plasma only in Bleeding Trauma Patients: Analysis of the Trauma Quality Improvement Program Database

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et al. 2021

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Background:The effectiveness of cryoprecipitate in trauma has not been well-established. In addition, the benefits of cryoprecipitate might have been overestimated in previous studies since the difference in the total amount of administered clotting factors was not considered. This study aimed to evaluate the benefits of the concurrent use of cryoprecipitate in combination with fresh frozen plasma (FFP) during the resuscitation of bleeding trauma patients.Methods: A retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database was conducted. Patients who received ≥4 units of packed red blood cells within the first 4 hours after arrival to the emergency department (ED) were dichotomized according to whether cryoprecipitate was used. The outcomes (primary: in-hospital mortality; secondary: 24-h mortality and incidence of complications) were compared using propensity score-matching analysis, in which the amount of total administered clotting factors was balanced.Results: A total of 19,008 patients (Cryo+FFP group: 3825; FFP only group: 15,183) were eligible for analysis, of whom 3103 propensity score-matched pairs were generated. Significantly lower in-hospital mortality (1217 [39.2%] patients in the Cryo+FFP group vs. 1295 [41.7%] in the FFP only group; odds ratio [OR], 0.90; 95% CI, 0.81-1.00) and 24-h mortality (735 [23.7%] vs. 886 [28.6%]; OR, 0.78; 95% CI, 0.69-0.87) were observed in the Cryo+FFP group than in the FFP only group; no significant difference was observed in the incidence of complications. Conclusions: Cryoprecipitate use combined with FFP was significantly associated with reduced mortality in bleeding trauma patients after adjustments were made for the dose of administered clotting factors. Future randomized controlled trials are warranted to confirm our results.

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Whole Blood in Trauma: A Review for Emergency Clinicians

Cited by 32 publications

References 47 publications

Effect of parachute delivery on red blood cell (RBC) and plasma quality measures of blood for transfusion

Effect of parachute delivery on red blood cell (RBC) and plasma quality measures of blood for transfusion

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

Clinical Benefits of Early Concurrent use of Cryoprecipitate and Plasma Compared with Plasma only in Bleeding Trauma Patients: Analysis of the Trauma Quality Improvement Program Database

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