Whole Blood for Blood Loss: Hemostatic Resuscitation in Damage Control
Abstract
Hemorrhagic shock and its complications are a major cause of death among trauma patients. The management of hemorrhagic shock using a damage control resuscitation strategy has been shown to decrease mortality and improve patient outcomes. One of the components of damage control resuscitation is hemostatic resuscitation, which involves the replacement of lost blood volume with components such as packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets in a 1:1:1:1 ratio. However, this is a strategy that is not applicable in many parts of Latin America and other low-and-middle-income countries throughout the world, where there is a lack of well-equipped blood banks and an insufficient availability of blood products. To overcome these barriers, we propose the use of cold fresh whole blood for hemostatic resuscitation in exsanguinating patients. Over 6 years of experience in Ecuador has shown that resuscitation with cold fresh whole blood has similar outcomes and a similar safety profile compared to resuscitation with hemocomponents. Whole blood confers many advantages over component therapy including, but not limited to the transfusion of blood with a physiologic ratio of components, ease of transport and transfusion, less volume of anticoagulants and additives transfused to the patient, and exposure to fewer donors. Whole blood is a tool with reemerging potential that can be implemented in civilian trauma centers with optimal results and less technical demand.
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Keywords
- Whole Blood
- Transfusion
- Whole Blood for Blood Loss
- Crystalloid Solutions
- Shock, Hemorrhagic
- Disseminated Intravascular Coagulation
- Trauma Centers
- Blood Safety
- Hemostatics
- Hypothermia
- Hypocalcemia
- Blood Coagulation Factors
- Respiratory Distress Syndrome
- Compartment Syndromes
Author Biographies
, Hospital Vicente Corral Moscoso, Division of Trauma and Acute Care Surgery, Cuenca, Ecuador. Universidad del Azuay, Escuela de Medicina. Cuenca, Ecuador.
https://orcid.org/0000-0002-9084-3030
, Medstar Georgetown University Hospital, Department of Surgery, Washington, USA. Washington Hospital Center. Washington, D.C., USA.
https://orcid.org/0000-0001-7180-5787
, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili, Cali Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.
https://orcid.org/0000-0003-4495-7405
, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA
https://orcid.org/0000-0001-6496-6275
, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
https://orcid.org/0000-0002-6128-0128
, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
https://orcid.org/0000-0002-5515-263X
, Center for Surgery and Public Health, Department of Surgery, Brigham & Women’s Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston – USA
https://orcid.org/0000-0002-2249-9960
, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.
https://orcid.org/0000-0002-4096-1434
, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Carrera 98 No. 18-49, Cali 760032, Colombia.
https://orcid.org/0000-0001-9829-8930
, Hospital Universitario del Valle, Cali, Colombia
https://orcid.org/0000-0003-2644-9319
, Critical Care Medicine. University of Pittsburgh. Pittsburgh, PA, USA.
https://orcid.org/0000-0003-4284-4693
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