Joint Trauma System, Defense Committee on Trauma, and Armed Services Blood Program consensus statement on whole blood

Abstract

Hemorrhage is the most common mechanism of death in battlefield casualties with potentially survivable injuries. There is evidence that early blood product transfusion saves lives among combat casualties. When compared to component therapy, fresh whole blood transfusion improves outcomes in military settings. Cold‐stored whole blood also improves outcomes in trauma patients. Whole blood has the advantage of providing red cells, plasma, and platelets together in a single unit, which simplifies and speeds the process of resuscitation, particularly in austere environments. The Joint Trauma System, the Defense Committee on Trauma, and the Armed Services Blood Program endorse the following: (1) whole blood should be used to treat hemorrhagic shock; (2) low‐titer group O whole blood is the resuscitation product of choice for the treatment of hemorrhagic shock for all casualties at all roles of care; (3) whole blood should be available within 30 min of casualty wounding, on all medical evacuation platforms, and at all resuscitation and surgical team locations; (4) when whole blood is not available, component therapy should be available within 30 min of casualty wounding; (5) all prehospital medical providers should be trained and logistically supported to screen donors, collect fresh whole blood from designated donors, transfuse blood products, recognize and treat transfusion reactions, and complete the minimum documentation requirements; (6) all deploying military personnel should undergo walking blood bank prescreen laboratory testing for transfusion transmitted disease immediately prior to deployment. Those who are blood group O should undergo anti‐A/anti‐B antibody titer testing.

Targeting repair of the vascular endothelium and glycocalyx after traumatic injury with plasma and platelet resuscitation

“…Finally, the use of whole blood resuscitation, specifically cold-stored low-titer group O whole blood, is having a resurgence in trauma care. The Joint Trauma System has put forth guidelines on whole blood transfusion in military settings, where whole blood transfusion has been shown to improve outcomes [122] , and there is growing evidence to support the use of whole blood in civilian trauma [123] . Importantly, whole blood can be administered more easily and rapidly than individual component therapy.…”

Whole blood use in trauma resuscitation: targeting prehospital transfusion

“…Although this practice change predominantly occurred in the civilian domain, whole blood continued to be a mainstay of resuscitation during the Iraq and Afghanistan wars [5]. Whole blood use was associated with a reduction in mortality and a decrease in blood product usage, and the Department of Defense Joint Trauma System and the Committee on Tactical Combat Casualty Care subsequently developed guidelines encouraging the use of whole blood in the prehospital setting [6,7]. A recent survey of 103 level one trauma centers reported that 42% of respondents utilize whole blood in the resuscitation of trauma patients, with all but 12% of those centers placing restrictions on number of units transfused [8].…”

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

“…Successful experience with fresh whole blood by the US military is well documented [ 125 ]. Recent studies suggest that LTOWB in resuscitation of civilian trauma is associated with a reduction in post-emergency department transfusions and increase likelihood of 24-h and 28-day survival [ 120 , 126 ].…”