Hemostatic Resuscitation

Advances in surgical and critical care medicine frequently parallel the course of armed conflict. Indeed, surgery is a specialty born of warfare and will continue to drive advancements as mankind finds new and more lethal methods of combat. As hemorrhage is far and away the leading cause of potentially survivable death on the battlefield, the methods of resuscitation and blood transfusion continue to evolve. The critical role that blood plays in resuscitation of the critically injured patient was first explored during World War I for the treatment of ‘wound shock’. Type O whole blood was collected in sterile glass bottles containing citrate and transfused into patients prior to surgery. During the years following World War I, blood component fractionation became available, blood banking was initiated, and the transfusion of packed red blood cells (RBCs), fresh frozen plasma (FFP) and platelets became a mainstay of the trauma management paradigm. However, in times of war the variable availability of short-lived platelets, FFP, and cryoprecipitate inevitably leads back to the resurrection of fresh whole blood transfusion. Fresh whole blood, though not without some risk, restores the hemostatic mechanism and provides volume and oxygen-carrying capacity.