The analysis and prospects of resustitation using fresh whole blood in modern medicine

Objective: to conduct a retrospective analysis of scientific sources on the experience of using whole blood in case of massive blood loss in servicemen with injuries and to assess the benefits of administering red blood cell, plasma, platelet components at different degrees of hypovolemic shock due to traumatic injuries during combat operations, to analyze the time of onset of resuscitation from injury at the II and III MES. Purpose: to study the benefits of administration of red blood cells (RBCs), plasma (fresh frozen plasma (FFP)), platelet (PC) components; in different degrees of hypovolemic shock due to traumatic injuries during hostilities, taking into account the time from injury to the start of blood transfusion according to two surgical hospitals of the second level of MES and one military hospital of the third level. Methods: the study was conducted on the basis of two surgical hospitals (level II MES) in the hottest combat zone and a military hospital (level III) in January 2024. Blood transfusion analysis was performed at level II - n=100, at level III - n=50 servicemen. A retrospective review of 85 domestic and foreign scientific papers was conducted using PubMed and Google Scholar databases. After reviewing the articles and reading their full texts, 22 sources were selected on the use of WB and CT at different degrees of severity of injury and hemorrhagic shock during military conflicts. The depth of the search was for the period 2014-2024. The study used bibliosemantic, system analysis, and statistical methods. Results. In all wars and military conflicts, hemorrhagic shock is the main cause of 81.5% of military deaths. At the second MES, in critical bleeding due to combat injuries, 72.5% of red blood cells + plasma components and 27.5% of red blood cells were preferred in servicemen with 43.0% of limb injuries, 28.0% of abdominal injuries, 17.0% of thoraco-abdominal injuries, and 13.0% of pelvic injuries. The degree of hypovolemic shock in patients indicates the seriousness of their condition: 64.0% had grade II shock, 29.0% - grade III, 7.0% - grade IV. At the second stage of medical evacuation, 60.0% of patients received 1-2 doses of transfusion therapy, 17.0% - 3 and 23.0% - more than 4 doses. At the III stage of medical evacuation, preference was given to RBCC+PC - 50.0%; RBCC- 43.0%; platelet components - 7.0% in the amount of 1 dose - 28.0%, 2 doses - 40.0, 3 doses - 22.0% and 4 doses - 10.0. At the third MES, 4.0% of patients received an infusion within the first day, while the largest number of transfusions was performed on the ninth day - 40.0%, on the sixth day - 25.0%, and on the twelfth day - 21.0%. Hyperthermia was reported in 10.0% of patients, acute renal failure (ARF) in 4.0%, and Quincke's edema in another 4.0%. Conclusions. Time to start infusion: Timely infusion therapy, particularly within 1-2 hours after injury (78.0% of cases), played a key role in achieving positive clinical outcomes. The study shows that effective infusion therapy in the early stages (II MES) led to a significant reduction in the severity of hypovolemic shock at stage III and minimized the number of complications after resuscitation.