The regional whole blood program in San Antonio, TX: A 3‐year update on prehospital and in‐hospital transfusion practices for traumatic and non‐traumatic hemorrhage

Low titer type O Rh‐D + whole blood (LTO + WB) has become a first‐line resuscitation medium for hemorrhagic shock in many centers around the World. Showing early effectiveness on the battlefield, LTO + WB is used in both the pre‐hospital and in‐hospital settings for traumatic and non‐traumatic hemorrhage resuscitation. Starting in 2018, the San Antonio Whole Blood Collaborative has worked to provide LTO + WB across Southwest Texas, initially in the form of remote damage control resuscitation followed by in‐hospital trauma resuscitation. This program has since expanded to include pediatric trauma resuscitation, obstetric hemorrhage, females of childbearing potential, and non‐traumatic hemorrhage. The objective of this manuscript is to provide a three‐year update on the successes and expansion of this system and outline resuscitation challenges in special populations.

[1]  S. Nicholson,et al.  Efficacy and Safety of Whole Blood Transfusion in Non-Trauma Patients. , 2021, The American surgeon.

[2]  D. Jenkins,et al.  Prehospital whole blood reduces early mortality in patients with hemorrhagic shock , 2021, Transfusion.

[3]  D. Jenkins,et al.  Whole blood transfusion reduces overall component transfusion in cases of placenta accreta spectrum: a pilot program , 2021, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[4]  S. Schauer,et al.  The Use of Whole Blood Transfusion During Non-Traumatic Resuscitation. , 2021, Military medicine.

[5]  Thomas M Pearce,et al.  The risk to future pregnancies of transfusing Rh(D)‐negative females of childbearing potential with Rh(D)‐positive red blood cells during trauma resuscitation is dependent on their age at transfusion , 2021, Vox sanguinis.

[6]  D. Jenkins,et al.  Operationalizing the Deployment of Low-Titer O-Positive Whole Blood Within a Regional Trauma System. , 2021, Military medicine.

[7]  D. S. Morris,et al.  Whole blood for postpartum hemorrhage: early experience at two institutions , 2020, Transfusion.

[8]  D. Jenkins,et al.  The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio, TX , 2019, ISBT Science Series.

[9]  B. Long,et al.  Whole Blood in Trauma: A Review for Emergency Clinicians. , 2019, The Journal of emergency medicine.

[10]  A. Peitzman,et al.  Prehospital Blood Product and Crystalloid Resuscitation in the Severely Injured Patient: A Secondary Analysis of the Prehospital Air Medical Plasma Trial. , 2019, Annals of surgery.

[11]  M. A. Meledeo,et al.  Optimizing whole blood storage: hemostatic function of 35‐day stored product in CPD, CP2D, and CPDA‐1 anticoagulants , 2019, Transfusion.

[12]  Anand K. Ramasubramanian,et al.  Cold-stored platelets: A product with function optimized for hemorrhage control. , 2019, Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis.

[13]  David M. Notrica,et al.  Massive transfusion in pediatric trauma: An ATOMAC perspective. , 2019, Journal of pediatric surgery.

[14]  S. Einav,et al.  Retrospective study to investigate fresh frozen plasma and packed cell ratios when administered for women with postpartum hemorrhage, before and after introduction of a massive transfusion protocol. , 2018, International journal of obstetric anesthesia.

[15]  G. Perkins,et al.  RePHILL: protocol for a randomised controlled trial of pre‐hospital blood product resuscitation for trauma , 2018, Transfusion medicine.

[16]  Shawn C. Nessen,et al.  Whole Blood Transfusion. , 2018, Military medicine.

[17]  James G. Chandler,et al.  Rapid TEG efficiently guides hemostatic resuscitation in trauma patients , 2018, Surgery.

[18]  J. Holcomb,et al.  Get ready: whole blood is back and it's good for patients , 2018, Transfusion.

[19]  D. Triulzi,et al.  Use of Uncrossmatched Cold-Stored Whole Blood in Injured Children With Hemorrhagic Shock , 2018, JAMA pediatrics.

[20]  D. Jenkins,et al.  Prehospital Transfusion for Gastrointestinal Bleeding. , 2017, Air medical journal.

[21]  D. Jenkins,et al.  Prehospital blood transfusions in pediatric trauma and nontrauma patients: a single-center review of safety and outcomes , 2017, Pediatric Surgery International.

[22]  E. Habermann,et al.  Prehospital Blood Transfusions in Non-Trauma Patients , 2016, World Journal of Surgery.

[23]  A. Peitzman,et al.  Taking the Blood Bank to the Field: The Design and Rationale of the Prehospital Air Medical Plasma (PAMPer) Trial , 2015, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[24]  D. Friedman,et al.  Reduced transfusion requirement with use of fresh whole blood in pediatric cardiac surgical procedures. , 2015, The Annals of thoracic surgery.

[25]  A. Peitzman,et al.  Pre-trauma center red blood cell transfusion is associated with improved early outcomes in air medical trauma patients. , 2015, Journal of the American College of Surgeons.

[26]  C. Wade,et al.  Prehospital Transfusion of Plasma and Red Blood Cells in Trauma Patients , 2015, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[27]  A. Nathens,et al.  Compliance with a massive transfusion protocol (MTP) impacts patient outcome. , 2015, Injury.

[28]  P. Spinella,et al.  Fresh whole blood transfusion for a combat casualty in austere combat environment. , 2014, Journal of special operations medicine : a peer reviewed journal for SOF medical professionals.

[29]  D. Lockey,et al.  The introduction of on-scene blood transfusion in a civilian physician-led pre-hospital trauma service , 2013, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[30]  Sue Williams,et al.  Characteristics and outcomes of patients administered blood in the prehospital environment by a road based trauma response team , 2013, Emergency Medicine Journal.

[31]  B. Burns,et al.  Prehospital blood transfusion: 5-year experience of an Australian helicopter emergency medical service , 2013, Critical Care.

[32]  Emma L. Enraght-Moony,et al.  The feasibility of civilian prehospital trauma teams carrying and administering packed red blood cells , 2012, Emergency Medicine Journal.

[33]  A. Shorr,et al.  Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients (CME) , 2011, Transfusion.