Review

. 2021 Jan 17;10(2):320.

doi: 10.3390/jcm10020320.

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

Mark Walsh^{1

2}, Ernest E Moore^{3

4}, Hunter B Moore⁴, Scott Thomas⁵, Hau C Kwaan⁶, Jacob Speybroeck¹, Mathew Marsee¹, Connor M Bunch¹, John Stillson¹, Anthony V Thomas¹, Annie Grisoli¹, John Aversa⁷, Daniel Fulkerson⁸, Stefani Vande Lune⁹, Lucas Sjeklocha¹⁰, Quincy K Tran¹⁰

Affiliations

¹ Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA.
² Departments of Emergency & Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA.
³ Ernest E. Moore Shock Trauma Center, Denver Health, Denver, CO 80204, USA.
⁴ Department of Surgery, University of Colorado Health Science Center, Denver, CO 80204, USA.
⁵ Department of Trauma Surgery, Memorial Leighton Trauma Center, Beacon Health System, South Bend, IN 46601, USA.
⁶ Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
⁷ Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
⁸ Department of Neurosurgery, Beacon Medical Group, South Bend, IN 46601, USA.
⁹ Emergency Medicine Department, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA.
¹⁰ The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

PMID: 33477257
PMCID: PMC7830337
DOI: 10.3390/jcm10020320

Review

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

Mark Walsh et al. J Clin Med. 2021.

. 2021 Jan 17;10(2):320.

doi: 10.3390/jcm10020320.

Authors

Affiliations

¹ Notre Dame Campus, Indiana University School of Medicine, South Bend, IN 46617, USA.
² Departments of Emergency & Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA.
³ Ernest E. Moore Shock Trauma Center, Denver Health, Denver, CO 80204, USA.
⁴ Department of Surgery, University of Colorado Health Science Center, Denver, CO 80204, USA.
⁵ Department of Trauma Surgery, Memorial Leighton Trauma Center, Beacon Health System, South Bend, IN 46601, USA.
⁶ Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
⁷ Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
⁸ Department of Neurosurgery, Beacon Medical Group, South Bend, IN 46601, USA.
⁹ Emergency Medicine Department, Navy Medicine Readiness and Training Command, Portsmouth, VA 23708, USA.
¹⁰ The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

PMID: 33477257
PMCID: PMC7830337
DOI: 10.3390/jcm10020320

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.

Keywords: blood component transfusion; blood transfusion; exsanguination; fibrinogen; hemostatics; thromboelastography.

PubMed Disclaimer

Conflict of interest statement

Ernest Moore, Hunter Moore, Scott Thomas, and Hau Kwaan have received research grants from Haemonetics Corporation (Braintree, Massachusetts, USA).

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

Affiliations

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

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