Department of Pediatrics, Washington University in St. Louis, St. Louis, MO 63110, USA.
Anesth Analg. 2012 Oct;115(4):751-8. doi: 10.1213/ANE.0b013e318261f40e. Epub 2012 Jul 4.
Transfusion support of patients with hemorrhagic shock has changed over time with the development of storage and processing methods. Transfusion medicine developed during World War I with the use of whole blood, and now in the developed world, component therapy predominates. In contrast, there is still clinical use of fresh whole blood (FWB) in the developing world, in a minority of children's hospitals, and in combat settings. Although there is a rationale for the use of FWB in massively bleeding patients compared with the use of individual components, it has rarely been analyzed in prospective randomized clinical trials. Recent retrospective studies in adult trauma and mixed critically ill patients have revived this decades-old controversial question of the value of FWB for patients with severe shock and coagulopathy or those at risk. The risks of FWB use have also been highlighted recently, which has caused some to focus on reducing these risks with alternative processing and storage methods. It is important to recognize that current processing and storage methods for components have also not been adequately explored to determine whether they affect clinical outcomes. In this article, we review potential benefits and risks of FWB use for patients with hemorrhagic shock from any cause, and how current and future processing and storage methods may affect efficacy and safety of FWB in this population. We intend this review to stimulate hypothesis generation and clinical investigation in determining when FWB may be indicated and how to optimally process and store FWB to maximize its risk-benefit ratio.
随着储存和处理方法的发展，失血性休克患者的输血支持也发生了变化。第一次世界大战期间，输血医学随着全血的使用而发展，而在发达国家，目前以成分治疗为主。相比之下，在发展中国家、少数儿童医院和战斗环境中仍在临床使用新鲜全血（FWB）。尽管与使用单个成分相比，FWB 在大量出血患者中具有一定的使用合理性，但很少有前瞻性随机临床试验对此进行分析。最近在成年创伤和混合危重症患者中的回顾性研究重新引发了这个几十年来关于 FWB 对严重休克和凝血功能障碍或有风险患者的价值的有争议问题。FWB 使用的风险最近也得到了强调，这导致一些人关注通过替代处理和储存方法来降低这些风险。重要的是要认识到，目前对成分的处理和储存方法也没有得到充分探索，以确定它们是否会影响临床结果。在本文中，我们回顾了 FWB 对任何原因导致的失血性休克患者的潜在益处和风险，以及当前和未来的处理和储存方法如何影响该人群中 FWB 的疗效和安全性。我们希望这篇综述能够激发假设的产生和临床研究，以确定何时可以使用 FWB 以及如何优化处理和储存 FWB，以最大限度地提高其风险效益比。
