Implementation of a protocol for prehospital transfusion of low-titer, leukocyte-depleted whole blood for civilian bleeding patients.

Blood component therapy is considered the gold standard for the treatment of the massively bleeding patient, but it can be challenging to perform outside the hospital environment. The successful experience from the military shows that whole blood can efficiently provide treatment for massively bleeding patients. Whole blood transfusion has been in use in Norway to some extent in paediatric cardiac surgery, but no major interest has been paid from the blood centres to implement the use of whole blood as an alternative or a supplement to traditional blood component therapy. On the other hand, the increasing number of reports showing a potential benefit of whole blood and the availability of the last generation whole blood leukocyte filters, allowing the platelets to remain in the blood product, has led to the first experiences with prehospital use of whole blood in Norway. Our institution is completing the planning of a program for the use of prehospital whole blood transfusion in the civilian setting, following the same trend at two other hospitals in Norway.