Use of Whole Blood in Civilian Trauma Resuscitation: Is It Better Than Component Therapy?

The leading cause of death in traumatic injury for both civilian and combat populations worldwide is hemorrhage,^1-4  with the majority of deaths occurring in the first 24 hours.⁵  Stopping hemorrhage with early and balanced resuscitation supports survival for injured patients.^6-8  The wide use of whole blood occurred successfully during World War II and remained the preferred resuscitation measure until the 1970s, when blood component therapy began to address the issue of access by providing longer storage times.^9,10 

Several studies have demonstrated a benefit of reduced mortality with the administration of a 1:1:1 ratio of fresh frozen plasma, platelets, and red blood cells (RBCs).^11-13  This benefit renewed interest in the use of whole blood in the combat setting. Additional research has shown that cold-stored, low-titer anti-A and anti-B type O whole blood (LTOWB) is being used more often...