Abstract
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.
Highlights
Rationale for the Adoption of Whole Blood and FixedRatio Resuscitation1.1
Due to the concerns about the validity of the PROPPR trial, which set the standard for the fixed 1:1:1 practice, we review the reasons for the widespread adoption of cold-stored whole blood (CSWB) in the United States for civilian urban trauma
It is not surprising that the only European randomized control trial (RCT) for using CSWB in the civilian urban population is in France, where the time spent in the field on resuscitation efforts is longer than the “scoop and run” strategy used in the United States, where physicians are not onboard ambulances [107]
Summary
Since 2016, many large United States academic centers have embarked upon an ambitious program to offer whole blood (WB) in the civilian and urban prehospital environment for severely hemorrhaging patients. This process required variances from the American Association of Blood Banks recommendations [1,2]. Some urban academic trauma systems with short transport times have been early adopters of CSWB. Many of these academic centers who advocate for trauma resuscitation with WB are led by trauma specialists with military backgrounds [1,2]. The mechanistic rationale for the provision of CSWB in the civilian and urban environment requires historical evaluation prior to its widespread adoption
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