Newer strategies from the use of blood and blood products: Lessons learned from recent wars

Abstract

The use of blood products for resuscitation has long been rooted in lessons learned from war. From preliminary attempts at blood transfusion during the Civil War to massive transfusion protocols in modern warfare, advances in the knowledge of blood products and their effective use in traumatic resuscitation has evolved through conflict. The last century in particular has seen multiple shifts in resuscitative strategies. World War I saw the first widespread introduction of blood as a resuscitation agent. By the end of the war, storage banks, crossmatching, and whole blood transfusions were employed throughout American and British field hospitals. Whole blood resuscitation inexplicably fell out of favor in the decades that followed until World War II. Experiences with high casualty rates due to hemorrhagic shock during World War II prompted a shift back toward whole blood and away from primary plasma resuscitation. The separation of whole blood into components for storage and transport first occurred on a large scale during the Vietnam War, and this popularized component therapy for many decades. Military experience in Iraq and Afghanistan led to many key trials in the early 2000s that supported the use of balanced blood product resuscitation. Current guidelines recommend a 1:1:1 ratio of blood products with minimal administration of crystalloid fluids. Nonrandomized studies show a survival benefit for whole blood resuscitation in civilian and military settings, and most authors agree that whole blood is logistically easier to transfuse at the bedside. Randomized clinical trials will need to be conducted to show whether whole blood has a clear survival advantage over balanced resuscitation with component therapy.