Global and national experience of resuscitation using fresh whole blood in modern medicine: analysis and prospects

Abstract

Resuscitation for hemorrhagic shock caused by critical bleeding remains one of the main areas of military medicine because massive bleeding remains one of the greatest threats to life among servicemen on the battlefield and civilians. Statistics show that 54.0%-81.0% of deaths are associated with hypovolaemic shock of the 3rd and 4th degree as a result of massive traumatic injuries from various types of modern weapons, which currently tend to have greater consequences for both military personnel and civilians. Military data from recent military conflicts underlines the importance of improving and implementing effective modern strategies for transfusion of blood and its components at the pre-hospital (stabilisation point) and hospital stages, which is a key task to increase the survival rate among injured servicemen and women. Recent studies have shown an increased survival rate of servicemen with traumatic haemorrhagic shock within 24 hours and up to one month by 13.0% who received whole blood transfusion (hereinafter - WB) compared to patients who received component therapy (hereinafter - CT) with similar severity of injury. The analysis of data on patients with haemorrhagic shock who had a higher injury severity score on admission (ISS: 27 vs. 20; blood pressure 103 to 114; higher lactate level 4.2 vs. 3.5) who received whole blood transfusion showed a 4-fold increase in survival with a 60.0% reduction in total transfusions and a lower rate of complications (occurrence of sepsis). In recent years, and especially during military conflicts, WB resuscitation with a low group O blood titer has become commonplace in both the military and civilian population, which are also not protected from bombardment by modern weapons (missiles, chess pieces, drones) and may represent an ideal resuscitation intervention. According to researchers, in patients with an increased likelihood of mortality at the prehospital stage, transfusion of whole blood with a low group O titer has been shown to be safer and more effective than resuscitation of blood components: up to 48.0% reduction in 4-hour mortality, up to 30.0% reduction in 28 days after injury. At the time of the full-scale war in Ukraine, the relevance of WB resuscitation is of particular importance as an ideal transfusion medium for the treatment of military personnel and civilians with severe injuries, critical bleeding accompanied by severe haemorrhagic shock. Blood transfusion is critical for providing emergency care at the pre-hospital stage (‘stabilisation point’), performing surgeries and stabilising the condition of the injured. Ensuring the collection, processing, transportation, storage and safe and effective WBT is now essential in the event of massive sanitary losses.