Whole blood for blood loss: hemostatic resuscitation in damage control. [Review]

MedStar author(s):
Citation: Colombia Medica. 51(4):e4044511, 2020 Dec 30.PMID: 33795899Institution: MedStar Washington Hospital CenterDepartment: MedStar General Surgery ResidencyForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Blood Transfusion | *Hemostatic Techniques | *Resuscitation/mt [Methods] | *Shock, Hemorrhagic/et [Etiology] | *Shock, Hemorrhagic/th [Therapy] | *Wounds and Injuries/co [Complications] | Humans | Injury Severity ScoreYear: 2020ISSN:
  • 0120-8322
Name of journal: Colombia medica (Cali, Colombia)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. Copyright (c) 2020 Colombia Medica.All authors: Badiel M, Caicedo Y, Garcia A, Granados M, Guzman-Rodriguez M, Himmler AN, Macia C, Ordonez CA, Orlas C, Parra MW, Puyana JC, Salamea-Molina JC, Serna JJ, Valencia-Angel LIOriginally published: Colombia Medica. 51(4):e4044511, 2020 Dec 30.Fiscal year: FY2021Fiscal year of original publication: FY2021Digital Object Identifier: ORCID: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33795899 Available 33795899

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. Copyright (c) 2020 Colombia Medica.

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