Reshaping Trauma Resuscitation: The Shift Back to Blood Products and the Impact on the Trauma Diamond


In the evolving field of trauma care, blood products have seen several dramatic shifts from being a cornerstone of care to being replaced with saline during the HIV crisis, and now seeing a resurgence with fresh whole blood (FWB) and plasma. This article explores this journey, focusing mainly on the impact of FWB on the trauma diamond.

Section 1 – Historical Overview: Blood Products in Resuscitation

Blood products have been essential in trauma resuscitation since World War I, with blood banks established in World War II[^1^]. The HIV epidemic in the 1980s led to a shift towards saline solutions due to infection risks[^2^]. However, advances in infection testing and growing evidence of the efficacy of blood products have reinstated their importance in trauma care.

Section 2 – The Trauma Diamond and the Role of FWB:

The trauma diamond—comprising hypothermia, acidosis, coagulopathy, and hypocalcemia—is a key concept in managing trauma patients. FWB, with all components of blood in natural proportions, plays a pivotal role in addressing these elements:

  • Coagulopathy: FWB supports clot formation, reducing haemorrhage risk.
  • Hypothermia: FWB is administered warm, helping maintain the patient’s temperature.
  • Acidosis: The buffering capacity of FWB helps regulate pH levels.
  • Hypocalcemia: FWB contains ionized calcium, essential for coagulation.

Section 3 – Advancements through THOR:

The Trauma Hemostasis and Oxygenation Research (THOR) network have contributed significantly to the understanding and implementing FWB in trauma care[^3^]. Their work underpins the shift back to FWB, providing evidence-based training and highlighting the benefits of FWB over other resuscitation fluids.

Section 4 – Future Perspectives:

As we continue to recognize the importance of FWB in trauma resuscitation, ongoing research and training are essential. Organizations like THOR are instrumental in driving this shift, paving the way for improved patient outcomes in trauma care.


[^1^]: Starr, D. (2006). Blood: An Epic History of Medicine and Commerce. Harper Perennial.
[^2^]: Schafer, A. I. (1994). The history of blood transfusion before the twentieth century–Part I. Perspectives in Biology and Medicine, 37(4), 491–512.
[^3^]: THOR. (2022). THOR Whole Blood Transfusion Course. Retrieved from

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