Collections > Master's Papers > Physician Assistant Program > Fresh Whole Blood Transfusions: Efficacy, Limitations, and the Future

Background: Loss of blood from traumas suffered on the battlefield is the most common cause of death among potentially treatable injuries in frontline military operations (Keenan and Riesberg 2017). Cessation of blood loss and fluid repletion have been major driving factors that can reduce battlefield casualties. Once the hemorrhage has been stopped, the next step is to replace lost volume to decrease cardiac failure or shock (Eastridge et al. 2012; Butler 2017). Uncontrolled hemorrhage can lead to the "trauma triad of death", which consists of hypothermia, acidosis, and impaired coagulation (Howard et al. 2017). Hemostatic resuscitation involves the blood components resembling whole blood. The goals are to avoid metabolic acidosis, hypothermia, treating coagulopathy and stabilizing the patient as soon as possible (Nickson n.d.). The resuscitation fluids of choice for casualties in hemorrhagic shock, listed from most to least preferred are: whole blood; plasma, RBCs and platelets in 1:1:1 ratio; plasma and RBCs in 1:1 ratio; plasma or RBCs alone, and crystalloid fluids (Nickson n.d.). Between October 2001 and June 2011, 4,596 battlefield fatalities were analyzed. Non-compressible hemorrhage is the cause of over 2/3 of battlefield deaths, which makes hemorrhages the leading cause of potentially survivable deaths in combat (Keenan and Riesberg 2017). The major body region bleeding focus accounting for mortality were torso 48%, extremities 31%, and neck/groin/ axilla region 21% (Eastridge et al. 2012). Casualties with severe hemorrhagic injury, the odds of KIA mortality were 83% lower for casualties who needed and received pre-hospital blood transfusion (Shackelford et al. 2017). Evaluating the influences on mortality is helpful for planning efforts that optimize placement, proximity, and provision of timely and effective transport and treatment capabilities to minimize casualty risk (Malsby et al. 2013). Combat wounded on today’s battlefield experience the highest survival rate in history. Advances in battlefield medicine during the conflicts in Iraq and Afghanistan have included the effective use of tourniquets, damage control resuscitation, trauma system development, en route care, use of tranexamic acid, and advanced topical hemostatic dressings (Malsby et al. 2013). In 2008, there was a mandate that all the injured personnel evacuation to surgeon must occur in less than 60 minutes, “The Golden Hour”, that contributed to the lowest mortality rate of any conflict in history (Keenan and Riesberg 2017). Component therapy remains the mainstay in trauma resuscitation. In prolonged field care, access to packed red blood cells, platelets, and fresh frozen plasma is often limited (Keenan and Riesberg 2017). Transfusion of fresh whole blood has been used when access to CT in these settings are limited or have been fully utilized . The process of separating and reconstituting blood can lessen its effectiveness. Current Prolonged Field Care standards identified that the best practice for transfusions would be to maintain a stock of pRBC and FFP and have type-specific donors identified for immediate FWB draw (Keenan and Riesberg 2017). PICOT​ ​Question:​ ​What​ ​are​ ​the​ ​limitations​ ​of​ ​Fresh​ ​Whole​ ​Blood​ ​transfusions​ ​or administration​ ​of​ ​blood​ ​products​ ​in​ ​prolonged​ ​point​ ​of​ ​injury​ ​care​ ​on​ ​the​ ​battlefield?