Comparing Mortality Outcomes Between Whole Blood Versus Component Therapy

Authors

• Jessica MacLaurin Kemp, University of LynchburgFollow

Specialty

Surgical Critical Care

Advisor

Kyle Cunningham

Abstract

The purpose of this review is to evaluate whether whole blood (WB) transfusion improves mortality compared with balanced component therapy (CT) in adult civilian trauma patients with hemorrhagic shock. A comprehensive review of civilian and military literature was conducted to identify studies evaluating mortality, transfusion needs, physiologic effects, and the feasibility of WB use. While current civilian resuscitation relies on a 1:1:1 ratio of packed red blood cells, plasma, and platelets to approximate WB, this approach necessitates separate storage and administration, potentially delaying hemostasis during the critical "golden hour" of trauma. Low-titer group O whole blood (LTOWB) has re-emerged as a potential solution, aiming to simplify logistics and correct trauma-induced coagulopathy more rapidly than traditional CT. Military data reports significant improvements in early survival and simplified logistics: however, a direct bridge to civilian care is complicated by differences in storage and injury patterns. Military success provides a strong proof of concept for the use of WB, but these benefits must be carefully validated within the unique logistical and demographic constraints of civilian trauma centers. Current civilian studies show that early WB use is associated with lower early mortality and fewer transfusions than CT. WB may also improve efficiency during early trauma management and allow for faster control of bleeding during the initial resuscitation period. Despite these promising signals, the lack of large, multicenter randomized controlled trials (RCTs) remains the primary barrier to universal guideline adoption.

Recommended Citation

Kemp JM. Comparing Mortality Outcomes Between Whole Blood Versus Component Therapy. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).