Himmler Amber, Galarza Armijos Monica Eulalia, Naranjo Jeovanni Reinoso, Patiño Sandra Gioconda Peña, Sarmiento Altamirano Doris, Lazo Nube Flores, Pino Andrade Raul, Aguilar Hernán Sacoto, Fernández de Córdova Lenin, Augurto Cecibel Cevallos, Raykar Nakul, Puyana Juan Carlos, Salamea Juan Carlos
Department of Surgery, MedStar Georgetown University Hospital, Washington DC, District of Columbia, USA.
Department of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador.
Trauma Surg Acute Care Open. 2021 Nov 18;6(1):e000758. doi: 10.1136/tsaco-2021-000758. eCollection 2021.
Hemorrhagic shock is a major cause of mortality in low-income and middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood (WB) program in Latin America and to discuss the outcomes of the patients who received WB.
We conducted a retrospective review of patients resuscitated with WB from 2013 to 2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, shock index, Revised Trauma Score in trauma patients, intraoperative crystalloid (lactated Ringer's or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length of stay, and in-hospital mortality.
The sample includes a total of 101 patients, 57 of which were trauma and acute care surgery patients and 44 of which were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. The average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of WB. Overall mortality was 13.86% (14 of 101) in the first 24 hours and 5.94% (6 of 101) after 24 hours.
Implementing a WB protocol is achievable in LMICs. WB allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a WB program implemented in a civilian hospital in Latin America.
Level IV.
失血性休克是低收入和中等收入国家（LMICs）死亡的主要原因。许多LMICs的机构缺乏足够的资源来合理进行平衡复苏。本研究旨在描述拉丁美洲全血（WB）项目的实施情况，并讨论接受WB治疗的患者的结局。
我们对2013年至2019年接受WB复苏的患者进行了回顾性研究。为失血性休克患者持续提供5单位O+ WB。收集的变量包括性别、年龄、治疗患者的科室、输注的WB单位数、输注的成分单位数、入院生命体征、入院血红蛋白、休克指数、创伤患者的修订创伤评分、术中晶体液（乳酸林格氏液或生理盐水）和胶体液（5%人白蛋白）的输注情况、输血反应症状、住院时间和院内死亡率。
样本共包括101例患者，其中57例为创伤和急性护理手术患者，44例为妇产科患者。没有患者出现与输血反应一致的症状。平均休克指数为1.16（±0.55）。患者平均接受1.66（±0.80）单位的WB。前24小时的总体死亡率为13.86%（101例中的14例），24小时后为5.94%（101例中的6例）。
在LMICs中实施WB方案是可行的。WB能够更有效地进行止血复苏，非常适合资源有限的环境。据我们所知，这是拉丁美洲一家 civilian 医院实施的WB项目的首次描述。
四级。
