LAUSR

There is mounting evidence demonstrating that survival is improved when transfusions are provided early in the resuscitation of traumatically injured patients. In the military setting, a retrospective study of 502 combat casualties demonstrated that the provision of primarily red blood cells (RBC) within approximately 30 min of injury improved both 24-h and 30-day survival compared with patients who did not receive any blood products or who received them later in the resuscitation. In the civilian setting, the multicenter Prehospital Air Medical Plasma (PAMPER) trial found that 30-day mortality was improved in patients who received 2 units of plasma while en route to the hospital compared with patients who received the prehospital standard of care, which in many cases was crystalloid fluid only. wThese data are beginning to change the resuscitation practices of first responders and hospital-based trauma systems. No longer are crystalloids and colloids considered the first-line resuscitation fluid. The U.S. Department of Defense's Committee on Tactical Combat Casualty Care recommends low titer group O whole blood (LTOWB) as the optimal prehospital resuscitation product. In both Norway and Israel, RhD-positive LTOWB is carried by search and rescue helicopters for immediate use as the patient is being transported to definitive care. The city of San Antonio, Texas, has RhD-positive LTOWB available on many of its emergency medical services' helicopters and ground ambulances. Hospitals in other American cities are also implementing LTOWB as their first choice for resuscitating bleeding patients. One potential logistical concern regarding LTOWB is the quandary of whether to provide RhD-positive or RhD-negative LTOWB to emergency medical services and trauma hospitals. Ideally, all prehospital blood products would be RhD-negative to avoid potentially sensitizing females of childbearing potential to the RhD antigen, with the potential for causing hemolytic disease of the fetus and newborn (HDFN) during subsequent pregnancies. However, finding sufficient numbers of donors who are qualified to donate LTOWB is a challenge; at one Abbreviations: DNA, deoxyribonucleic acid; HLA, human leukocyte antigen; ICU, intensive care unit; IV, intravenous; LTOWB, low titer group O whole blood; RBC, red blood cells; RhIg, Rh immune globulin.