Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Curr Opin Crit Care. 2024 Jun 1;30(3):209-216. doi: 10.1097/MCC.0000000000001140. Epub 2024 Feb 6.
Transfusion therapy commonly supports patient care during life-threatening injury and critical illness. Herein we examine the recent resurgence of whole blood (WB) resuscitation for patients in hemorrhagic shock following trauma and other causes of severe bleeding.
A growing body of literature supports the use of various forms of WB for hemostatic resuscitation in military and civilian trauma practice. Different types of WB include warm fresh whole blood (FWB) principally used in the military and low titer O cold stored whole blood (LTOWB) used in a variety of military and civilian settings. Incorporating WB initial resuscitation alongside subsequent component therapy reduces aggregate blood product utilization and improves early mortality without adversely impacting intensive care unit length of stay or infection rate. Applications outside the trauma bay include prehospital WB and use in patients with nontraumatic hemorrhagic shock.
Whole blood may be transfused as FWB or LTOWB to support a hemostatic approach to hemorrhagic shock management. Although the bulk of WB resuscitation literature has appropriately focused on hemorrhagic shock following injury, extension to other etiologies of severe hemorrhage will benefit from focused inquiry to address cost, efficacy, approach, and patient-centered outcomes.
输血疗法常用于支持创伤和其他严重出血原因导致的失血性休克患者的生命救治。本文探讨了近期创伤后失血性休克患者全血复苏治疗的复苏的再次兴起。
越来越多的文献支持在军事和民用创伤实践中使用各种形式的全血进行止血复苏。不同类型的全血包括主要用于军事的新鲜冷冻全血（FWB）和用于各种军事和民用环境的低滴度 O 型冷藏全血（LTOWB）。将全血初始复苏与随后的成分治疗相结合，可减少血液制品的总体使用量，并降低早期死亡率，而不会延长重症监护病房的住院时间或增加感染率。创伤室外的应用包括院前全血和用于非创伤性失血性休克的患者。
可以输注新鲜冷冻全血或低滴度 O 型冷藏全血来支持失血性休克管理的止血方法。尽管全血复苏的大部分文献都集中在创伤后失血性休克，但扩展到其他严重出血的病因需要进行有针对性的研究，以解决成本、疗效、方法和以患者为中心的结果等问题。
