The use of whole blood transfusion in emergency medicine

Whole blood was the first human blood product to be transfused in modern medicine, seeing widespread use during the final months of World War I. With the advent of blood component therapy and the concept of using intravenous crystalloid fluids for initial resuscitation of hemorrhagic shock in trauma, whole blood transfusion had been forgotten as a therapeutic possibility during the larger part of the 20th century. Owing to the successful military use of whole blood in the early 1990s, extending to the early 2000s, whole blood has resurfaced as a lucrative therapeutic option for civilian trauma in the early 2010s, with approximately 25 % of level I trauma centers in the United States using whole blood transfusions in 2020. However, a large part of the developed world is still hesitant on the benefits of using whole blood both in prehospital and in-hospital trauma resuscitations, owing to the relative scarcity of high-quality evidence (especially randomized controlled trials) on its effectiveness and safety when compared to the current standard of care - blood component therapy. With recently published prospective studies demonstrating either noninferiority or marginal superiority of whole blood transfusion to blood component transfusion, interest in the use of whole blood has once again increased. This narrative review aims to present the history, technical aspect and current evidence for the use of whole blood in both the military and civilian trauma settings in a concise, succinct manner and inform the reader on the contexts and situations in which whole blood transfusion might provide the greatest benefit, both logistics and cost-wise and mortality-wise.