Whole-Blood Transfusion From Empiricism to Evidence: A Narrative Review

Area of Science:

• Trauma Resuscitation
• Hemorrhagic Shock Management
• Blood Product Utilization

Background:

• Hemorrhage is a leading cause of preventable trauma death, often occurring before hemorrhage control.
• Whole blood is reemerging as a resuscitation strategy, but its role is debated due to heterogeneous evidence.
• Safety, implementation, and access issues influence the adoption of whole blood.

Purpose of the Study:

• To review the current evidence on whole blood use in trauma resuscitation.
• To evaluate the benefits and challenges of whole blood compared to component therapy.
• To inform the practice of trauma teams and health systems regarding whole blood implementation.

Main Methods:

• Systematic review of military, civilian, and prehospital literature.
• Analysis of observational studies and emerging prehospital data.
• Assessment of safety considerations and implementation challenges.

Main Results:

• Whole blood provides red cells, plasma factors, and platelets in physiologic proportions.
• Evidence suggests potential benefits in selected patients, including reduced transfusion burden.
• The literature is predominantly observational, with limited randomized controlled trials.

Conclusions:

• Whole blood is an efficient, physiologically complete strategy for early hemorrhage resuscitation.
• It may improve outcomes in selected patients and reduce operational complexity.
• Definitive guidance requires adequately powered randomized trials for widespread adoption.