Usefulness of fresh whole blood transfusion in the surgical management of war hemorrhagic shock in the austere environment

Hemorrhage accounts for 40% of trauma fatalities and is the leading cause of preventable death in trauma. Haemostatic surgery is improved by an early and aggressive correction of acute traumatic coagulopathy. In situations like combat casualty care, the use of fresh whole blood (FWB) provides all the blood components, including platelets and fully functional clotting factors. We report the case of two patients with a left basi-thoracic stab wound responsible for a massive hemothorax as the source of hemorrhagic shock who had surgery at the Medical Treatment Facility in Kabul. The existence of hemorrhagic shock with externalized hemorrhage and biological coagulopathy led immediately to initiate collection of FWB. Left anterolateral thoracotomy was performed in both cases to achieve hemostasis of active bleeding from intercostal arteries. In the same time, early and aggressive correction of coagulopathy was started including early transfusion of packed red blood cells followed by FWB, administration of freeze-dried plasma, fibrinogen (clotagene®) and infusion of hypertonic fluid solutions. At the end of surgical procedure, hemoglobin concentration, prothrombin ratio and fibrinogen level were improved with favorable outcome for both patients. These two observations highlight the benefits of FWB which provides red blood cells, platelets and coagulation factors in good proportions, and simultaneously contributes to the correction of coagulopathy and hypothermia.