scholarly journals Whole Blood, Fixed Ratio, or Goal-Directed Blood Component Therapy for the Initial Resuscitation of Severely Hemorrhaging Trauma Patients: A Narrative Review

2021 ◽  
Vol 10 (2) ◽  
pp. 320
Author(s):  
Mark Walsh ◽  
Ernest E. Moore ◽  
Hunter B. Moore ◽  
Scott Thomas ◽  
Hau C. Kwaan ◽  
...  
Keyword(s):  
Whole Blood ◽  
Fixed Ratio ◽  
Narrative Review ◽  
Blood Component ◽  
Trauma Patients ◽  
Initial Resuscitation ◽  
Blood Component Therapy ◽  
Historical Developments ◽  
Comparative Trials ◽  
Selection Of

This narrative review explores the pathophysiology, geographic variation, and historical developments underlying the selection of fixed ratio versus whole blood resuscitation for hemorrhaging trauma patients. We also detail a physiologically driven and goal-directed alternative to fixed ratio and whole blood, whereby viscoelastic testing guides the administration of blood components and factor concentrates to the severely bleeding trauma patient. The major studies of each resuscitation method are highlighted, and upcoming comparative trials are detailed.

A Pilot Study of Stored Low Titer Group O Whole Blood + Component Therapy versus Component Therapy Only for Civilian Trauma Patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anaar E. Siletz ◽  
Kevin J. Blair ◽  
Richelle J. Cooper ◽  
N. Charity Nguyen ◽  
Scott J. Lewis ◽  
...  
Keyword(s):  
Pilot Study ◽  
Whole Blood ◽  
Blood Component ◽  
Trauma Patients ◽  
Civilian Trauma ◽  
Blood Component Therapy ◽  
Titer Group

scholarly journals Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

2022 ◽  
Vol 11 (2) ◽  
pp. 356
Author(s):  
James H. Lantry ◽  
Phillip Mason ◽  
Matthew G. Logsdon ◽  
Connor M. Bunch ◽  
Ethan E. Peck ◽  
...  
Keyword(s):  
Whole Blood ◽  
Blood Component ◽  
Trauma Centers ◽  
Blood Products ◽  
Massive Blood Loss ◽  
Initial Resuscitation ◽  
Blood Component Therapy ◽  
Resuscitation Strategy ◽  
History Of ◽  
Current Guidelines

Modern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy—especially in austere or challenging environments—is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival.

Whole Blood Versus Conventional Blood Component Massive Transfusion Protocol Therapy in Civilian Trauma Patients

2021 ◽  
pp. 000313482110497
Author(s):  
Janet S. Lee ◽  
Abid D. Khan ◽  
Franklin L. Wright ◽  
Robert C. McIntyre ◽  
Warren C. Dorlac ◽  
...  
Keyword(s):  
Whole Blood ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Blood Component ◽  
Trauma Patients ◽  
Massive Transfusion Protocol ◽  
Civilian Trauma ◽  
Transfusion Volume ◽  
Blood Component Therapy ◽  
Transfusion Protocol

Background Military data demonstrating an improved survival rate with whole blood (WB) have led to a shift toward the use of WB in civilian trauma. The purpose of this study is to compare a low-titer group O WB (LTOWB) massive transfusion protocol (MTP) to conventional blood component therapy (BCT) MTP in civilian trauma patients. Methods Trauma patients 15 years or older who had MTP activations from February 2019 to December 2020 were included. Patients with a LTOWB MTP activation were compared to BCT MTP patients from a historic cohort. Results 299 patients were identified, 169 received LTOWB and 130 received BCT. There were no differences in age, gender, or injury type. The Injury Severity Score was higher in the BCT group (27 vs 25, P = .006). The LTOWB group had a longer transport time (33 min vs 26 min, P < .001) and a lower arrival temperature (35.8 vs 36.1, P < .001). Other hemodynamic parameters were similar between the groups. The LTOWB group had a lower in-hospital mortality rate compared to the BCT group (19.5% vs 30.0%, P = .035). There were no differences in total transfusion volumes at 4 hours and 24 hours. No differences were seen in transfusion reactions or hospital complications. Multivariable logistic regression identified ISS, age, and 24-hour transfusion volume as predictors of mortality. Discussion Resuscitating severely injured trauma patient with LTOWB is safe and may be associated with an improved survival.

scholarly journals Blood Component Therapy

2018 ◽  
Vol 9 (2) ◽  
pp. 142-147
Author(s):  
Shanaz Karim ◽  
Ehteshamul Hoque ◽  
Md Mazharul Hoque ◽  
Syeda Masooma Rahman ◽  
Kashfia Islam
Keyword(s):  
Red Blood Cells ◽  
Whole Blood ◽  
Blood Cells ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Packed Red Blood Cells ◽  
Medical College ◽  
Blood Component Therapy ◽  
Fresh Frozen ◽  
Cellular Components

Transfusion medicine has undergone advancements since its initiation in the early 20th century. One of these was the discovery that blood can be divided into individual components and delivered separately. Today, blood transfusions nearly always consist of the ad-ministration of 1 or more components of blood. Whole blood transfusion is now limited to situations involving massive resuscitation (trauma ) The most familiar cellular components include packed red blood cells (PRBC), washed PRBC, leukoreduced PRBC and pooled or aphaeresis platelets. Plasma products such as FFP or cryoprecipitate, ant hemophilic factor (CRYO). The transfusion of red blood cells (RBCs), platelets, fresh-frozen plasma (FFP), and cryoprecipitate has the potential of improving clinical outcomes in perioperative and peripartum settings. These benefits include improved tissue oxygenation and decreased bleeding. However, transfusions are not without risks or costs. With the advent of blood component therapy, each unit of whole blood collected serves the specific needs of several, rather than a single patient.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 142-147

scholarly journals Whole blood versus component therapy for haemostatic resuscitation of major bleeding: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e043967
Author(s):  
Anna E Ssentongo ◽  
Paddy Ssentongo ◽  
Emily Heilbrunn ◽  
Lacee Laufenberg Puopolo ◽  
Vernon M Chinchilli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Major Bleeding ◽  
Whole Blood ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Primary Data ◽  
Blood Component ◽  
Geographical Differences ◽  
Blood Component Therapy ◽  
Haemostatic Resuscitation

IntroductionThere is a renewed interest in the use of whole blood (WB) to manage patients with life-threatening bleeding. We aimed to estimate mortality and complications risk between WB and blood component therapy for haemostatic resuscitation of major bleeding.MethodsWe will conduct a systematic review and meta-analysis of studies published between 1 January 1980 and 1 January 2020, identified from PubMed and Scopus databases. Population will be patients who require blood transfusion (traumatic operative, obstetric and gastrointestinal bleeding). Intervention is WB transfusion such as fresh WB (WB unit stored for less than 48 hours), leukoreduced modified WB (with platelets removed during filtration), warm fresh WB (stored warm at 22°C for up to 8 hours and then for a maximum of an additional 24 hours at 4°C). The primary outcomes will be the 24-hour and 30-day survival rates (in-hospital mortality). Comparator is blood component therapy (red blood cells, fresh-frozen plasma and platelets given together in a 1:1:1 unit ratio). The Cochrane risk of bias tool for randomised controlled trials and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) for observation studies will be used to assess the risk of bias of included studies. We will use random-effects models for the pooling of studies. Interstudy heterogeneity will be assessed by the Cochran Q statistic, where p<0.10 will be considered statistically significant and quantified by I2 statistic, where I2 ≥50% will indicate substantial heterogeneity. We will perform subgroup and meta-regression analyses to assess geographical differences and other study-level factors explaining variations in the reported mortality risk. Results will be reported as risk ratios and their 95% CIs.Ethics and disseminationNo ethics clearance is required as no primary data will be collected. The results will be presented at scientific conferences and published in a peer-reviewed journal.

scholarly journals Quality Assessment of Established and Emerging Blood Components for Transfusion

2016 ◽  
Vol 2016 ◽  
pp. 1-28 ◽  
Author(s):  
Jason P. Acker ◽  
Denese C. Marks ◽  
William P. Sheffield
Keyword(s):  
Whole Blood ◽  
Blood Product ◽  
Standard Of Care ◽  
Blood Component ◽  
Industrialized Countries ◽  
Platelet Concentrates ◽  
Donor Blood ◽  
Additional Manufacturing ◽  
Blood Component Therapy ◽  
Nonstandard Conditions

Blood is donated either as whole blood, with subsequent component processing, or through the use of apheresis devices that extract one or more components and return the rest of the donation to the donor. Blood component therapy supplanted whole blood transfusion in industrialized countries in the middle of the twentieth century and remains the standard of care for the majority of patients receiving a transfusion. Traditionally, blood has been processed into three main blood products: red blood cell concentrates; platelet concentrates; and transfusable plasma. Ensuring that these products are of high quality and that they deliver their intended benefits to patients throughout their shelf-life is a complex task. Further complexity has been added with the development of products stored under nonstandard conditions or subjected to additional manufacturing steps (e.g., cryopreserved platelets, irradiated red cells, and lyophilized plasma). Here we review established and emerging methodologies for assessing blood product quality and address controversies and uncertainties in this thriving and active field of investigation.

scholarly journals The Utilization of Viscoelastic Testing to Guide Blood Component Therapy and Adjunctive Hemostatic Therapy for Postpartum Hemorrhage: A Narrative Review

2019 ◽  
pp. 272-286
Author(s):  
Baumgartner S ◽  
Shariff F ◽  
Vande Lune SA ◽  
Zackariya N ◽  
Grisoli A ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Point Of Care ◽  
Narrative Review ◽  
Blood Component ◽  
Clinical Parameters ◽  
Rotational Thromboelastometry ◽  
Coagulation Tests ◽  
Blood Component Therapy ◽  
History Of ◽  
Hemostatic Therapy

This narrative review discusses the history of the pathophysiologic principles and utilization of point-of-care (POC) viscoelastic tests (VETs) in the definition and treatment of postpartum hemorrhage (PPH). This paper addresses the epidemiology of PPH, describes the hemostatic changes that occur in pregnancy and in PPH, and demonstrates the utilization of viscoelastic testing in the identification and treatment of patients with PPH. Additionally, a description of rotational thromboelastometry (ROTEM) and thromboelastography (TEG), the two most commonly used VETs, is detailed in this paper. VETs have only recently been used to guide blood component therapy (BCT) in trauma in the last decade. The recent increased utilization of VETs to guide BCT in PPH is following a similar trend with a delay of ten years. In a similar fashion to the trauma literature, which expanded greatly within this last decade, the literature concerning the use of VETs in PPH has also increased in the last few years. However, because of differing pathophysiologies associated with the coagulopathy of PPH verses traumatic-induced coagulopathy (TIC), utilization of VETs has been more refined and focused on the VETs’ capacity to determine low fibrinogen and to guide the utilization of blood components and prohemostatic agents. The identification and treatment of PPH depends on clinical parameters, conventional coagulation tests (CCTs) including Clauss fibrinogen, and VETs. Successful treatment of PPH will no doubt include utilization of all three strategies with an increasing utilization of VETs in the future.

scholarly journals Whole blood transfusion versus component therapy in adult trauma patients with acute major haemorrhage

2020 ◽  
Vol 37 (6) ◽  
pp. 370-378 ◽  
Author(s):  
Pascale Avery ◽  
Sarah Morton ◽  
Harriet Tucker ◽  
Laura Green ◽  
Anne Weaver ◽  
...  
Keyword(s):  
Whole Blood ◽  
Statistical Difference ◽  
Damage Control ◽  
Controlled Trial ◽  
Primary Objective ◽  
Major Haemorrhage ◽  
Blood Component ◽  
Trauma Patients ◽  
Transfusion Strategy ◽  
Significant Difference

ObjectiveIn the era of damage control resuscitation of trauma patients with acute major haemorrhage, transfusion practice has evolved to blood component (component therapy) administered in a ratio that closely approximates whole blood (WB). However, there is a paucity of evidence supporting the optimal transfusion strategy in these patients. The primary objective was therefore to establish if there is an improvement in survival at 30 days with the use of WB transfusion compared with blood component therapy in adult trauma patients with acute major haemorrhage.MethodologyA systematic literature search was performed on 15 December 2019 to identify studies comparing WB transfusion with component therapy in adult trauma patients and mortality at 30 days. Studies which did not report mortality were excluded. Methodological quality of included studies was interpreted using the Cochrane risk of bias tool, and rated using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsSearch of the databases identified 1885 records, and six studies met the inclusion criteria involving 3255 patients. Of the three studies reporting 30-day mortality (one randomised controlled trial (moderate evidence) and two retrospective (low and very low evidence, respectively)), only one study demonstrated a statistically significant difference between WB and component therapy, and two found no statistical difference. Two retrospective studies reporting in-hospital mortality found no statistical difference in unadjusted mortality, but both reported statistically significant logistic regression analyses demonstrating that those with a WB transfusion strategy were less likely to die.ConclusionRecognising the limitations of this systematic review relating to the poor-quality evidence and limited number of included trials, it does not provide evidence to support or reject use of WB transfusion compared with component therapy for adult trauma patients with acute major haemorrhage.PROSPERO registration numberCRD42019131406.

scholarly journals Transfusion Strategies in the Pre-Hospital Setting: Evaluating the Logistical Benefits of Pre-Hospital Whole Blood Transfusion, and a National Survey of Pre-Hospital Blood Transfusion

2021 ◽  
Author(s):  
Harriet Tucker ◽  
Laura Green ◽  
Karim Brohi ◽  
Rebecca Cardigan ◽  
Ross Davenport ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
National Survey ◽  
Whole Blood ◽  
Hospital Setting ◽  
Flow Time ◽  
Transfusion Practice ◽  
Blood Component ◽  
Trauma Patients ◽  
Time Analysis ◽  
Blood Component Transfusion

Abstract BackgroundPre-hospital blood component transfusion poses logistical challenges. Current patterns of pre-hospital blood use across the UK are not known. A potential benefit of providing a single combined component of whole blood is reduced need for multiple steps of administering separate components and more efficient use of time and resources by medical staff. .Objectivesto undertake a detailed time-analysis of the steps of pre-hospital combined component transfusion against separate blood component transfusion, and to determine current UK pre-hospital transfusion practice and users’ optimal pre-hospital transfusion strategyMethodsA three-arm cross-over major haemorrhage simulation study compared: flow-time (time from decision-to-transfuse [DTT] to complete transfusion); touch-time (direct team ’hands on’ contact time with transfusion process); and number of steps, people and equipment required for transfusion of 2 units of RCP [arm-A], 2 RBC + 2 TP [arm-B] or RBC + 2 Lyoplas [arm-C]). A national survey of current and optimal pre-hospital transfusion strategies was sent to 22 UK Air Ambulance Services (AAS) and 27 Major Trauma Centres (MTC) in December 2019. ResultsThe simulation demonstrated that arm-A had a shorter flow-time (median 6min 31sec vs. 12min 20 sec, vs 16min 29 sec) and touch-time (median 2min 31 seconds vs. 5min 21sec vs. 15min 3sec) than arm-B and arm-C respectively, and required fewer steps, equipment and checks. 18 MTCs and 18 AAS responded to the national survey (response rates of 67 and 82%). 10 transfused RBC/plasma (5 TP/5 Lyoplas), 4 RBC only, 2 Lyoplas only, 1 RBC/Lyoplas/Fibrinogen, and 1 ’red cell and plasma’ (only available at one hospital site). 89% replied that a combined component transfusion would be desirable, as it would reduce patient mortality (83%) and tasks on scene (75%). ConclusionThe time-analysis established the benefits for combined pre-hospital component transfusion in trauma patients. The national survey demonstrates the variation in current pre-hospital transfusion practice and reiterates that combined component transfusion pre-hospital may have logistical advantages over separate components.

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