Whole blood resuscitation has emerged as a promising alternative to conventional component therapy for patients in hemorrhagic shock. Animal studies and clinical evidence in both civilian and military populations have shown improved outcomes with whole blood. While further research is needed to establish optimal patient selection criteria, dosing, and transfusion practices, the use of whole blood in resuscitation has the potential to save lives and improve outcomes. Whole blood provides balanced levels of red cells, plasma, and platelets, mimicking normal physiology and sealing leaks in the clotting cascade that often develop. The available clinical evidence suggests that whole blood resuscitation may provide advantages over component therapy in certain patient populations and clinical settings.
Cite this paper
Al-Darwish, A. S. and Althowimer, Z. A. (2023). The Whole Story: A Comprehensive Review of Whole Blood Resuscitation for Hemorrhagic Shock. Open Access Library Journal, 10, e475. doi: http://dx.doi.org/10.4236/oalib.1110475.
Weinberg, J.A., McGwin, G., Marques, M.B., et al. (2008) Transfusions in the Less Severely Injured: Does Age of Transfused Blood Affect Outcomes? The Journal of Trauma, 65, 794-798. https://doi.org/10.1097/TA.0b013e318184aa11
Holcomb, J.B., Tilley, B.C., Baraniuk, S., et al. (2015) Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients with Severe Trauma: The PROPPR Randomized Clinical Trial. JAMA, 313, 471-482.
https://doi.org/10.1001/jama.2015.12
Cotton, B.A., Reddy, N., Hatch, Q.M., et al. (2011) Damage Control Resuscitation Is Associated with a Reduction in Resuscitation Volumes and Improvement in Survival in 390 Damage Control Laparotomy Patients. Annals of Surgery, 254, 598-605.
https://doi.org/10.1097/SLA.0b013e318230089e
Duchesne, J.C., Kimonis, K., Marr, A.B., et al. (2010) Damage Control Resuscitation in Combination with Damage Control Laparotomy: A Survival Advantage. The Journal of Trauma, 69, 46-52. https://doi.org/10.1097/TA.0b013e3181df91fa
Callcut, R.A., Johannigman, J.A., Kadon, K.S., et al. (2013) The Why and How Our Trauma Patients Die: A Prospective Multicenter Western Trauma Association Study. Journal of Trauma and Acute Care Surgery, 74, 686-691.
Nunez, T.C., Voskresensky, I.V., Dossett, L.A., et al. (2009) Early Prediction of Massive Transfusion in Trauma: Simple as ABC (Assessment of Blood Consumption)? The Journal of Trauma, 66, 346-352.
https://doi.org/10.1097/TA.0b013e3181961c35
Rahe-Meyer, N., Solomon, C., Hanke, A., et al. (2013) Effects of Fibrinogen Concentrate as First-Line Therapy during Major Aortic Replacement Surgery: A Randomized, Placebo-Controlled Trial. Anesthesiology, 118, 40-50.
https://doi.org/10.1097/ALN.0b013e3182715d4d
Borgman, M.A., Spinella, P.C., Perkins, J.G., et al. (2007) The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital. The Journal of Trauma, 63, 805-813.
https://doi.org/10.1097/TA.0b013e3181271ba3
Holcomb, J.B., Zarzabal, L.A., Michalek, J.E., et al. (2011) Increased Platelet:RBC Ratios Are Associated with Improved Survival after Massive Transfusion. The Journal of Trauma, 71, S318-S328. https://doi.org/10.1097/TA.0b013e318227edbb
Stinger, H.K., Spinella, P.C., Perkins, J.G., et al. (2008) The Ratio of Fibrinogen to Red Cells Transfused Affects Survival in Casualties Receiving Massive Transfusions at an Army Combat Support Hospital. The Journal of Trauma, 64, S79-S85.
https://doi.org/10.1097/TA.0b013e318160a57b
Jenkins, D., Stubbs, J., Williams, S., et al. (2014) Whole Blood Use in the Field: A Simplified Protocol for Collection and Transfusion. Shock, 41, 76-83.
https://doi.org/10.1097/SHK.0000000000000114
Zielinski, M.D., Johnson, M.A., Jenkins, D., et al. (2008) Fresh Whole Blood Transfusions in Coalition Military, Foreign National, and Enemy Combatant Patients during Operation Iraqi Freedom at a U.S. Combat Support Hospital. World Journal of Surgery, 32, 2-6. https://doi.org/10.1007/s00268-007-9201-5
