title: Hemostatic resuscitation for massive hemorrhage with warm fresh whole blood in a patient with severe blunt trauma.
abstract: A 24-year-old male Navy soldier was struck on the left thigh by a ruptured cable and was subsequently thrown into the sea. Initial evaluation showed an Injury Severity Score of 34. Core body temperature was 34.1°C. Laboratory data included a hemoglobin level of 4.5 g/dL and a hematocrit of 13.3%. Prothrombin time was prolonged (>100 seconds), international normalized ratio was elevated (9.99), and partial thromboplastin time was elevated (>180 seconds). The patient was treated for hypothermia, coagulopathy, and metabolic acidosis during resuscitation. The patient was transfused with 16,320 mL of blood during the first 24 hours following the accident, including 4500 mL (18 units) of warm fresh whole blood (WFWB) donated by the patient's military colleagues. The patient was successfully resuscitated, and the injured leg was salvaged. Component therapy can afford replacement of specific deficiencies or requirements, decrease the risk of transfusion-transmitted infectious diseases, and improve resource utilization. However, a protocol of early transfusion with WFWB should be considered during resuscitation following massive hemorrhage in specific conditions such as battle fields or urgent situations.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Yuan-Hao
authors.initials: YH
authors.lastname: Liu
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC. Electronic address: cvschao@gmail.com.
authors.forename: Chia-Sheng
authors.initials: CS
authors.lastname: Chao
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Yee-Phoung
authors.initials: YP
authors.lastname: Chang
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Hsien-Kuo
authors.initials: HK
authors.lastname: Chin
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D005264:Femoral Fractures / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006358:Hot Temperature; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D035002:Lower Extremity / Q000098:blood supply / Q000293:injuries / Q000601:surgery*; D008297:Male; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult
keywords: damage control surgery; exsanguination; hemostatic resuscitation; massive transfusion; warm fresh whole blood