The Story of Blood for Shock Resuscitation: How the Pendulum Swings

Abstract

Whole blood transfusion (WBT) began in 1667 as a treatment for mental illness, with predictably poor results. Its therapeutic utility and widespread use were initially limited by deficiencies in transfusion science and antisepsis. James Blundell, a British obstetrician, was recognized for the first allotransfusion in 1825. However, WBT did not become safe and therapeutic until the early 20^th century, with the advent of reliable equipment, sterilization, and blood typing. The discovery of citrate preservation in World War I allowed a separation of donor from recipient and introduced the practice of blood banking. During World War II, Elliott and Strumia were the first to separate whole blood into blood component therapy (BCT), producing dried plasma as a resuscitative product for "traumatic shock." During the 1970s, infectious disease, blood fractionation, and financial opportunities further drove the change from WBT to BCT, with few supporting data. Following a period of high-volume crystalloid and BCT resuscitation well into the early 2000s, measures to avoid the resulting iatrogenic resuscitation injury were developed under the concept of damage control resuscitation. Modern transfusion strategies for hemorrhagic shock target balanced BCT to reapproximate whole blood. Contemporary research has expanded the role of WBT to therapy for the acute coagulopathy of trauma and the damaged endothelium. Many US trauma centers are now using WBT as a front-line treatment in tandem with BCT for patients suffering hemorrhagic shock. Looking ahead, it is likely that WBT will once again be the resuscitative fluid of choice for patients in hemorrhagic shock.

Figure 1.

Dr James Blundell with Gravitator (modified from Baskett, with permission from Elsevier).

Figure 2.

Dr Oswald Robertson with Winchester bottle (modified from Robertson, with permission from BMJ).

Figure 3.

Dr John Elliott with TransfusoVac (modified from Schmidt with permission from Wiley).

Figure 4.

Standard military 250 cc plasma package. (A) Front of box; (B) back of box; (C) tops removed from cans of distilled water and plasma, with contents showing and ready for removal; (D) contents removed from cans. Pictured on the right are (E) Dr Max Strumia, (F) Captain Douglas Kendrick, and (G) Commander Lloyd Newhouser (modified from Kendrick and Coates).