MADISON, Wis. – UW Health Med Flight doctors and nurses as well as trauma center surgeons have a new tool to help save a person in the moments following a traumatic injury.
Starting in late October, Med Flight began using Type O whole blood to help resuscitate people who experience shock due to extreme blood loss from a traumatic injury. Similar to traditional blood transfusions, whole blood is obtained from blood donors, but is not subsequently divided into its individual components.
Historically in the United States, when a person experiences massive blood loss, to keep blood pressure close to normal, first responders will infuse an intravenous solution, often normal saline or lactated ringers, which are a mixture of sodium chloride, sodium lactate, potassium chloride and calcium chloride, into the bloodstream.
Ground ambulances haven’t traditionally had the capability to give whole blood, often due to operational, logistical and financial constraints of providing a blood transfusion, according to Dr. Ryan Newberry, UW Health Med Flight physician and assistant medical director.
However, air ambulance services have traditionally carried some variation of the different blood components, for example, red blood cells or plasma. Whole blood is different in that it has all of the components and in the ratios of an otherwise healthy person, he said.
“For a person in shock from severe blood loss, this is crucial as we now can start replacing everything that has been lost,” Newberry said. “This helps not only the vital signs but also with carrying oxygen to the tissues and making new clots which can temporarily slow down or stop the bleeding.”
In the U.S., trauma is a leading cause of death and disability. The shock that can result from a traumatic injury has a mortality rate that approaches 20% in the first 24 hours following the injury, according to Newberry, who is also an assistant professor of emergency medicine at the University of Wisconsin School of Medicine and Public Health.
Furthermore, national data have shown that not only are more than half of potentially preventable deaths due to hemorrhage, but around 85% of the roughly 30,000 preventable deaths in the U.S. occur before the person arrives at the hospital, he said.
“Recent evidence from international, civilian and military studies have demonstrated that the provision of blood products within the first hour of injury significantly impacts the survival of these patients,” Newberry said.
Additionally, in-hospital survival improved, and major complications like acute kidney injury, respiratory distress syndrome, deep vein thrombosis and pulmonary embolism were reduced by the use of whole blood following dramatic blood loss due to injury, according to a January 2022 study published in Current Anesthesiology Reports.
The study also showed a shorter hospital stay of nine days following a whole blood transfusion compared to 15 days with a non-whole-blood solution.
Wisconsin has approximately 130 hospitals, and around 10% of those are Level 1 or 2 trauma centers, and that translates into sometimes significant transport times to get a person from where their injury occurred to a trauma center, according to data from the Wisconsin Department of Health Services.
“The addition of whole blood to our capabilities allows our flight crews to begin resuscitation with the same blood product that the UW Health trauma center utilizes, essentially bringing this high level of critical care outside of the walls of the trauma center to wherever a person may be,” Newberry said.
Dr. Patrick Shahan, adult trauma medical director, UW Health, was part of the team that brought whole blood to use at UW Health. Implementing whole blood use in patient transport and in critical care surgery at the Level 1 trauma center at UW Health took a coordinated effort with regional blood banks, transfusion medicine specialists at UW Health, and most importantly, a valued and dedicated group of blood donors, according to Shahan, who is also an assistant professor of surgery, UW School of Medicine and Public Health.
“We are very excited to add whole blood transfusion as an option in treating our most critically injured trauma patients,” he said. “Because of the partners who helped make this happen, we are joining the forefront in treating life-threatening bleeding.”
