ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Whole blood resuscitation simplifies trauma massive transfusion by delivering red cells, plasma, and platelets in one product. In hemorrhagic shock, low-titer O whole blood is increasingly used because civilian data suggest better outcomes than component 1:1:1 resuscitation without more transfusion reactions.
Whole Blood in Trauma MTP
- Balanced resuscitation simplified: Whole blood addresses the classic MTP problem of playing catch-up with plasma, platelets, cryoprecipitate, and fibrinogen after packed cells have already started flowing.
- Low-titer O whole blood: LTOWB limits anti-A and anti-B antibody exposure, which is why uncrossmatched use is feasible even when the bleeding patient is not type O.
- Outcome signal in trauma: Recent civilian trauma data, including a 1,377-patient emergency-release cohort, link whole blood use to improved overall outcomes with no increase in transfusion reactions.
- Best use case: Whole blood is a scarce resource and fits true massive transfusion scenarios with rapid multi-product needs, not stable GI bleeding or routine anemia transfusion.
- Rh-negative childbearing patients: Low-titer O-positive whole blood may still be acceptable in exsanguinating Rh-negative women of childbearing age, paired with RhIG and obstetric follow-up; we get into that risk-benefit call in the episode.
- Transition to guided hemostasis: After the first 1 to 2 units, TEG or ROTEM can help tailor the next steps in resuscitation rather than continuing empiric product replacement.
- Program setup realities: A workable whole blood program depends on trauma, EMS, hematology, and the blood bank aligning on storage life, cost, and local MTP volume.
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References:
- Brill JB, Tang B, Hatton G, et al. Impact of Incorporating Whole Blood into Hemorrhagic Shock Resuscitation: Analysis of 1,377 Consecutive Trauma Patients Receiving Emergency-Release Uncrossmatched Blood Products. J Am Coll Surg. 2022;234(4):408-418. PMID: 35290259
Faculty
- Chris Hicks, MD
Chris Chris Hicks is an emergency physician, trauma team leader, educator, and speaker with expertise in resuscitation, simulation, and psychological performance in healthcare. His work has focused on areas such as mental practice, stress inoculation training, and improving team performance in high-stakes clinical environments. He has contributed to the development of interprofessional and simulation-based medical education initiatives and has collaborated with healthcare organizations on the design of systems, spaces, and teams to support high-performance care delivery. Chris is also a longtime supporter of the FOAMed movement and is widely recognized for his engaging and practical approach to medical education. Outside of medicine, he enjoys running, cycling, boxing, music, and spending time with his family.
- Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
- Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
