Scott and Dr. Holcomb addressed this previously in EMCrit 144. Pre-hospital component transfusion, to a blood banker, is a little scary from the regulatory perspective, but I have seen it done well (and it has been and is being studied in already published retrospective papers like the UPMC paper [http://www.journalacs.org/article/S1072-7515(15)00036-8/pdf], and in trials like PROHS [https://clinicaltrials.gov/ct2/show/NCT02272465] and PAMPer [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618798/]). As with other issues related to blood banking, my advice before moving down this pathway is to have detailed conversations with your blood bank team to understand just what it is they need and help them understand just what you need. As to whether it is actually EFFECTIVE, that’s a different question for which the above studies may give us a better answer (and I’ll leave to Scott to comment).

Sadly, there is no credible evidence to support any of the prehospital use of blood at this time. RePHILL is recruiting and will help answer this question. That doesn’t mean that it won’t work, physiologically, it should.

Well, David, I think that whole blood, especially “fresh whole blood” in massive transfusion situations makes sense! However, I think that if you ask any blood banker, we would say, “great idea…REALLLY hard to implement!” We aren’t really opposed, we just think it’s really difficult to do. Blood banks moved away from whole blood decades ago, when we started separating blood into components, and so the entire system is constructed to favor the use of individual parts of the blood. People smarter than me are thinking about this, though, and I hope that we can do something workable in the future, but for now, the 1:1:1-1:1:2 transfusion ratios discussed by Scott elsewhere is the closest approximation we can get in most places.

Eric, I’m sorry that I didn’t see this before now, but actually, it’s not the worst thing in the world, because of an article of which I just became aware (more in a sec). You are correct that there is not a ton of data on the use of viscoelastic hemostatic assays like TEG and ROTEM in trauma. There’s more in the cardiac surgery literature (and for the record, I’m a fan). The article I just mentioned is in the Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine (April 2017), lead author Fahrendorff (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390346/pdf/13049_2017_Article_378.pdf). It is a review and meta-analysis of TEG and ROTEM in acutely bleeding patients. As expected, it leans cardiac-heavy, but there’s a little bit on trauma, and the short answer is, “we don’t know yet.” I can’t speak for Scott, but my personal experience with TEG-ROTEM is also very cardiac surgery-heavy. I’ve seen it used in trauma, and I’ve heard people swear by it, but as you experienced, I’ve also heard people swear AT it!! From the cardiac experience I’ve had, though, I’d say that if you are going to use it, you have to “buy in.” What I mean is, I don’t think that picking… Read more »