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BACKGROUND Based on the improved outcomes achieved with fresh whole blood in cases of military trauma as well as with 1:1:1 transfusion strategies for massive traumatic hemorrhage in civilian settings, there has been resurgent interest in using whole blood for civilian trauma patients. There have been reports of giving up to 4 units of low‐titer cold‐stored O‐positive to these patients. This is the first modern report of a massive transfusion with unrestricted low‐titer group O whole blood (LTOWB) use in a civilian trauma patient. STUDY DESIGN AND METHODS This is a case report describing the resuscitation and massive transfusion of LTOWB of a 69‐year‐old man struck by an automobile. RESULTS While working to achieve hemorrhage control, the patient received 38 units of LTOWB, 13 units of RBCs, 12 units of fresh frozen plasma, 2 packs of platelets, and 2 units of cryoprecipitate. No evidence of hemolytic reaction was observed. The patient was O positive. Monitoring by thrombelastography revealed adequate clot initiation and propagation, but decreased clot strength (49.6 and 50.2) and a drop in fibrinogen (from 207 to 141) during the resuscitation. CONCLUSION This is the first report of a massive transfusion for civilian trauma based on cold‐stored whole blood in the recent era. While this patient suffered a tremendous burden of traumatic injury and his recovery is not yet complete, his LTOWB resuscitation was successful. Frequent monitoring of coagulation status with thrombelastography during utilization of LTOWB is indicated because the efficacy of its components (particularly platelets) is not yet fully understood.

Prognostic, level III.

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