Hemostatic Resuscitation

McMullin, N. R.; Holcomb, J. B.; Sondeen, J.

Component therapy is useful for the majority of patients when blood requirements are minimal and there is no associated coagulopathy. Of concern are requirements for massive transfusion and resuscitation that absorb resources and create a short-fall for patients whose injuries are less severe. Additionally, the conventional massive transfusion model of packed RBCs, plasma and platelets actually further dilutes the patient compared to the blood he or she has lost and thus is not the ideal fluid for patients who require this massive transfusion of products. Fresh whole blood has three vital properties: oxygen carrying capacity, volume, and hemostatic effect. In the austere environment of combat the practice of fresh whole blood transfusion has proven beneficial to patients who are coagulopathic and require massive transfusion. Appropriate use following established guidelines can be beneficial and may even be superior to packed RBCs. A fluid containing the vital properties of fresh whole blood would serve as a bridge to allow a patient to be resuscitated without initiating the ‘bloody cycle of death’ that is seen all too often in our current paradigm of massive resuscitation.