TY - JOUR
T1 - Whole Blood in Trauma
T2 - A Review for Emergency Clinicians
AU - Weymouth, Wells
AU - Long, Brit
AU - Koyfman, Alex
AU - Winckler, Christopher
N1 - Funding Information:
The authors would like to acknowledge the following for their contributions to this article as well as the emerging field at large: Dr. Julian Mapp, Dr. David Wampler and Dr. David Miramontes, of University of Texas Health San Antonio Department of Emergency Health Sciences, Office of the Medical Director, San Antonio, Texas; and Chief Michael Stringfellow of San Antonio Fire Department, Texas.
Publisher Copyright:
© 2019
PY - 2019/5
Y1 - 2019/5
N2 - Background: Blood products are a cornerstone of trauma resuscitation. From the historically distant battlefields of World War II through present-day conflict around the globe, whole blood (WB) has been a potent tool in the treatment of massive hemorrhagic shock. Component therapy with a targeted ratio of packed red blood cells, platelets, and plasma has previously been utilized. Objectives: This narrative review describes modern-day WB transfusion, its benefits, potential drawbacks, and implementation. Discussion: The current form of stored low-titer O WB seems to be the safest and most effective solution. There are many advantages to WB, including the maintenance of coagulation factors, the lack of subsequent thrombocytopenia, and the reduction of infused anticoagulant. Several studies suggest its utility in trauma. Most of the disadvantages of WB stem from a lack of prospective data on the topic, which are likely forthcoming. Logistical issues likely present the greatest barrier to this therapy, but an advanced prehospital protocol developed in San Antonio, Texas, has successfully overcome several of these challenges. Conclusions: Although stored WB holds promise, it is not without its distinct challenges, including logistical issues, which this article addresses. There are programs underway currently that demonstrate its feasibility in metropolitan areas. As demonstrated in military settings, WB is likely the ideal resuscitation fluid for civilian trauma in the prehospital and emergency department settings.
AB - Background: Blood products are a cornerstone of trauma resuscitation. From the historically distant battlefields of World War II through present-day conflict around the globe, whole blood (WB) has been a potent tool in the treatment of massive hemorrhagic shock. Component therapy with a targeted ratio of packed red blood cells, platelets, and plasma has previously been utilized. Objectives: This narrative review describes modern-day WB transfusion, its benefits, potential drawbacks, and implementation. Discussion: The current form of stored low-titer O WB seems to be the safest and most effective solution. There are many advantages to WB, including the maintenance of coagulation factors, the lack of subsequent thrombocytopenia, and the reduction of infused anticoagulant. Several studies suggest its utility in trauma. Most of the disadvantages of WB stem from a lack of prospective data on the topic, which are likely forthcoming. Logistical issues likely present the greatest barrier to this therapy, but an advanced prehospital protocol developed in San Antonio, Texas, has successfully overcome several of these challenges. Conclusions: Although stored WB holds promise, it is not without its distinct challenges, including logistical issues, which this article addresses. There are programs underway currently that demonstrate its feasibility in metropolitan areas. As demonstrated in military settings, WB is likely the ideal resuscitation fluid for civilian trauma in the prehospital and emergency department settings.
KW - blood products
KW - protocol
KW - transfusion
KW - whole blood
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U2 - 10.1016/j.jemermed.2019.01.024
DO - 10.1016/j.jemermed.2019.01.024
M3 - Article
C2 - 30904380
AN - SCOPUS:85062936381
SN - 0736-4679
VL - 56
SP - 491
EP - 498
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 5
ER -