Bad Blood: Blood Transfusions in Trauma

Jay Johannigman, MD FACS, Colonel USAFR MC FS, Division of Trauma and Surgical Critical Care University Hospital in Cincinnati speaks on blood transfusion at the 2015 annual Southwest Trauma & Acute Care Symposium. The first recorded blood transfusion was in 1667. The first in the US was in the early 1900s. Blood typing was first recognized during this time, as well. Whole blood was first fully transfused by the British during the first World War. Component Therapy, which is where whole blood is collected, separated into component parts, and stored at ideal temperatures to last longer. They believed they come mix the components and it would return to whole blood, but that is not the case. ATLS Resuscitation does not work either, and kills two-thirds of patients. The Lethal Triad includes acidosis, hypothermia, and coagulopathy. Crystalloid Resuscitation is one way to put a patient here. Whole blood is the solution to these complications. The PROMMTT Trial found beginning at a 1:1 ratio of plasma and platelets on a trauma patients showed better outcomes. The PROP:P:R Trial tested whether 1:1 or 1:2 was better. 1:1 seemed better, but it was not statistically significant. He stresses that transfusion of blood is not associated with increased mortality, but it is the transfusion of old blood that is associated with increased mortality.