Date of Award
2027
Document Type
Capstone
Degree Name
Master of Science (MS)
Department
Physician Assistant Studies
Committee Chair
Ashley Kernicky
Abstract
Importance: Hemorrhage remains one of the leading preventable causes of trauma mortality, yet the optimal resuscitation strategy, using whole blood vs component therapy, remains debated. While component therapy has been standard in civilian trauma centers since the 2015 PROPPR trial, renewed interest in whole blood resuscitation, largely driven by military experience, has sparked reevaluation of its role in civilian trauma care.
Objective: This review aims to compare survival outcomes, transfusion volumes, coagulopathy correction, and complication rates between whole blood and component therapy resuscitation in adult trauma patients experiencing hemorrhagic shock.
Evidence Review: A PICO-guided PubMed/MEDLINE search with strict eligibility criteria, yielded eight sources representing over 60,000 patients across military and civilian settings.
Findings: Early observational studies and meta-analysis consistently showed a mortality benefit with whole blood resuscitation, supporting a conditional EAST guideline recommending its use. Two adequately powered phase 3 RCTs – SWiFT and TOWAR – however, found no statistically significant survival benefit of whole blood versus component therapy, challenging conclusions from earlier observational studies. Complication rates were comparable between resuscitation methods, and one pilot trial noted whole blood was associated with fewer total transfusion units.
Conclusion and Relevance: Current randomized evidence does not support a definitive survival advantage of whole blood over component therapy in trauma resuscitation. Instead, resuscitation method may place higher emphasis on logistical factors such as availability and transfusion efficiency. Additionally, further research is warranted for broader populations such as in-hospital, traumatic brain injury, and mass-casualty events to determine if whole blood provides meaningful benefit beyond logistical convenience.
Recommended Citation
Thynne H. Whole Blood versus Component Therapy in Traumatic Hemorrhagic Shock: A Comparative Review of Survival Outcomes. The PA Department Journal of Medical Science. 2026. https://digitalcommons.gardner-webb.edu/pa-department-journal-of-medical-science/89
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