Whole Blood Mitigates the Acute Coagulopathy of Trauma and Avoids the Coagulopathy of Crystalloid Resuscitation

Introduction The contributions of type and timing of fluid resuscitation to coagulopathy in trauma remain controversial. As part of a multifunctional resuscitation fluid research effort we sought to further characterize the coagulation responses to resuscitation; specifically as compared to whole blood. We hypothesized that early whole blood administration mitigates the acute coagulopathy of trauma by avoiding the coagulopathy of crystalloid resuscitation. Methods Anesthetized rhesus macaques underwent poly-traumatic, hemorrhagic shock, then a crossover study design resuscitation (n=6 each) with either whole-blood-first (WB-1st) followed by crystalloid (CR); or CR-1st followed by WB. Resuscitation strategies were as followed: WB-1st received 50% shed blood in 30 minutes, followed by 2x shed blood volume (SBV) of CR over 30 minutes and 1x SBV CR over 60 minutes, where CR-1st received 2x SBV of CR over 30 minutes, followed by 50% of shed blood in 30 minutes, and 1x SBV CR over 60 minutes. Blood samples were collected at baseline, end-of-shock (EOS), end-of-first (R1), end-of-second (R2) resuscitation stages, and end-of-resuscitation (EOR) for assessment (thromboelastometry, platelet aggregation, and plasmatic coagulation factors). Statistical analyses: 2-way ANOVA with Bonferroni correction and t-tests, significance: p

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