Transfusion. 2019 Jul;59(7):2177-2179

# Low titer group O whole blood for prehospital hemorrhagic shock: It is an offer we cannot refuse.

Spinella P, Gurney J, Yazer M

Traumatic hemorrhagic shock carries very high morbidity and mortality. In adult trauma the 30‐day mortality rate ranges between 20% and 25%, whereas in children it is approximately 50%. Trauma is not only the most common cause of death in patients 1 to 46 years of age, it is also the most common cause of years of life lost for all patients less than 75 years of age. Traumatic hemorrhagic shock is the most common cause of preventable death after injury, accounting for approximately 30,000 deaths per year in the US. The vast majority of these deaths, 25,000 per year in the US, occur in the prehospital phase of resuscitation. The time from injury to death from traumatic hemorrhage is short, ranging from 1 to 3 hours from injury, with the average time to death being 1.6 hours. The most severely injured succumb in less than 30 minutes. Therefore when severe traumatic hemorrhage occurs, it must be recognized and addressed expeditiously: minutes matter.

Damage control resuscitation has been developed as a bundle of care intended to reduce morbidity and mortality from traumatic hemorrhagic shock. In both military and civilian trauma and transfusion communities, the debate continues whether cold‐stored LTOWB is optimal compared to individual blood components for in‐hospital resuscitation of patients with traumatic hemorrhagic shock. In the prehospital phase of resuscitation, there is less debate about the benefits of LTOWB over conventional components for traumatic shock. Shock and coagulopathy occur quickly after injury; survival improves the earlier we treat shock and coagulopathy.

US military trauma systems in collaboration with the Armed Services Blood Procurement Office have dramatically changed prehospital resuscitation in the past decade from exclusively using crystalloid/colloids to now where blood products are very commonly available prehospital. Trauma systems in the US are also working together with blood suppliers to coordinate donor recruitment and inventory management at all hospitals and emergency medical systems. Emergency medical systems in the US are increasingly starting to incorporate LTOWB for prehospital resuscitation. This is a big change in transfusion medicine. Trauma and transfusion medicine communities need to work together to improve outcomes for patients with severe bleeding in the prehospital setting. Moving forward, we should leave the clear fluids and take the whole blood. It is an offer we cannot refuse our patients.