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Comment & Response
October 14, 2020

Whole-Blood Resuscitation of Injured Patients’ Plasma

Author Affiliations
  • 1University of Pittsburgh Medical Center, Department of Surgery, University of Pittsburgh
  • 2Department of Pathology, University of Pittsburgh, University of Pittsburgh Medical Center
JAMA Surg. 2021;156(1):101-102. doi:10.1001/jamasurg.2020.4116

In Reply We thank Richard et al for their thoughtful comments in response to our Surgical Innovation “Whole-Blood Resuscitation of Injured Patients: Innovating From the Past.”1 Many valid points are raised in their discussion of cold-stored low-titer anti-A and anti-B group O whole blood resuscitation in trauma. While it is true that the survival benefit associated with prehospital blood product transfusion is most pronounced in the event of longer transport times, “longer” times are relative; in a 2019 secondary analysis2 of 2 combined civilian randomized clinical trials of prehospital plasma transfusion, the survival benefit of plasma transfusion was apparent if the transport time exceeded only 20 minutes,2 while in a study of injured soldiers, prehospital transfusions were associated with reduced 24-hour mortality if they were administered within 15 minutes of medical evacuation rescue.3 Thus, using the time criteria alone, only the patients with the shortest transport times would not benefit from transfusions. In addition, the benefit of early hemostatic resuscitation with whole blood extends beyond survival because recipients of whole blood in general require fewer subsequent blood product transfusions, have faster resolution of shock, and less abnormal coagulation parameters as compared with those receiving component products.

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