Prehospital transfusion of low titer cold-stored whole blood through the intraosseous route in a trauma patient with hemorrhagic shock

Abstract

Background: Damage control resuscitation, avoidance of dilutional coagulopathy, and increased blood component therapy reduce mortality after major trauma hemorrhage. Improved outcomes seen in recent warfare have placed whole blood as the preferred product for resuscitation of severe traumatic hemorrhage. As of 2018, flight physicians of the Israeli Airborne Combat Search and Rescue Unit (ACSRU) treat these patients with low titer cold-stored O-positive whole blood (LTCSO⁺ WB). Intraosseous (IO) is the preferred route if intravenous access is not available. To date, no study has described the administration of LTCSO⁺ WB via the IO route in the prehospital setting.

Case report: We present a case of whole blood transfusion via the IO route in a 30-year-old car accident patient who suffered major injuries and developed severe hemorrhagic shock. Intravenous access could not be obtained at the scene. En route, two units of LTCSO⁺ WB were administered, using an IO hand drill, and the patient's hemodynamic status improved. The patient survived the injury with a good outcome.

Conclusion: This is the first report of whole blood infusion via the IO route in traumatic hemorrhagic shock in the prehospital setting. Our positive experience suggests that this approach may have a role in hemorrhagic trauma patients when intravenous access cannot be obtained.