Whole Blood for Civilian Urban Trauma Resuscitation: Historical, Present, and Future Considerations

Mark Walsh*, Dietmar Fries, Ernest Moore, Hunter Moore, Scott Thomas, Hau C. Kwaan, Mathew K. Marsee, Anne Grisoli, Ross McCauley, Stefani Vande Lune, Swetha Chitta, Sudhir Vyakaranam, Dan Waxman, Michael T. McCurdy, Donald Zimmer, Bhavesh Patel, Jecko Thachil

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Whole blood (WB) has been used for more than a century for far-forward combat resuscitation. Following the Iraq/Afghanistan combat, maritime, and austere environment use of WB for the resuscitation of severely hemorrhaging patients, there has been an increasing use of WB for the civilian urban resuscitation environment population. The impetus for this was not just improved outcomes in far-forward hospitals, which had different populations and different needs than the civilian urban population, but also an application of the lessons suggested by recent 1:1:1 plasma:platelets:packed red cells fixed-ratio studies for patients with massive transfusion needs. Mechanistic, logistic, and standardization concerns have been addressed and are evolving as the WB project advances. A small number of studies have been published on WB in the civilian urban trauma population. In addition, European experience with viscoelastic testing and resuscitation with fibrinogen and prothrombin complex concentrate has provided another viewpoint regarding the choice of resuscitation strategies for severely bleeding trauma patients in urban civilian environments. There are randomized controlled trials in process, which are testing the hypothesis that WB may be beneficial for the civilian urban population. Whether WB will improve mortality significantly is now a matter of intense study, and this commentary reviews the history, mechanistic foundations, and logistical aspects for the use of WB in the civilian trauma population.

Original languageEnglish (US)
Pages (from-to)221-234
Number of pages14
JournalSeminars in thrombosis and hemostasis
Issue number2
StatePublished - Mar 1 2020


  • civilian
  • cold-stored whole blood
  • combat
  • fibrinogen concentrate therapy
  • fixed ratios
  • prothrombin complex concentrate therapy
  • whole blood

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine


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