title: Whole blood: the future of traumatic hemorrhagic shock resuscitation.
abstract: Toward the end of World War I and during World War II, whole-blood transfusions were the primary agent in the treatment of military traumatic hemorrhage. However, after World War II, the fractionation of whole blood into its components became widely accepted and replaced whole-blood transfusion to better accommodate specific blood deficiencies, logistics, and financial reasons. This transition occurred with very few clinical trials to determine which patient populations or scenarios would or would not benefit from the change. A smaller population of patients with trauma hemorrhage will require massive transfusion (>10 U packed red blood cells in 24 h) occurring in 3% to 5% of civilian and 10% of military traumas. Advocates for hemostatic resuscitation have turned toward a ratio-balanced component therapy using packed red blood cells-fresh frozen plasma-platelet concentration in a 1:1:1 ratio due to whole-blood limited availability. However, this "reconstituted" whole blood is associated with a significantly anemic, thrombocytopenic, and coagulopathic product compared with whole blood. In addition, several recent military studies suggest a survival advantage of early use of whole blood, but the safety concerns have limited is widespread civilian use. Based on extensive military experience as well as recent published literature, low-titer leukocyte reduced cold-store type O whole blood carries low adverse risks and maintains its hemostatic properties for up to 21 days. A prospective randomized trial comparing whole blood versus ratio balanced component therapy is proposed with rationale provided.
authors.affiliation: *Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; †Air Force Medical Operations Agency, Lackland AFB, Texas; ‡Department of Transfusion Medicine, Orebro University Hospital, Orebro, Sweden; §Department of Immunology and Transfusion Medicine, Haukeland University Hospital; ∥Institute of Clinical Science, University of Bergen; and ¶Norwegian Navy Special Command Forces, Haakonsvern, Bergen, Norway.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Murdock
authors.forename: Olle
authors.initials: O
authors.lastname: Berséus
authors.forename: Tor
authors.initials: T
authors.lastname: Hervig
authors.forename: Geir
authors.initials: G
authors.lastname: Strandenes
authors.forename: Turid Helen
authors.initials: TH
authors.lastname: Lunde
mesh_terms: D000017:ABO Blood-Group System; D055371:Acute Lung Injury / Q000209:etiology; D001793:Blood Preservation; D001803:Blood Transfusion / Q000379:methods*; D006086:Graft vs Host Disease / Q000209:etiology; D006489:Hemostatic Techniques; D006801:Humans; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000628:therapy
chemical_list: D000017:ABO Blood-Group System