The Story of Blood for Shock Resuscitation: How the Pendulum Swings.

Whole blood transfusion (WBT) began in 1667 as a treatment for mental illness, with predictably poor results. Its therapeutic utility and widespread use were initially limited by deficiencies in transfusion science and antisepsis. James Blundell, a British obstetrician, was recognized for the first allotransfusion in 1825. However, WBT did not become safe and therapeutic until the early 20th century, with the advent of reliable equipment, sterilization, and blood typing. The discovery of citrate preservation in World War I allowed a separation of donor from recipient and introduced the practice of blood banking. During World War II, Elliott and Strumia were the first to separate whole blood into blood component therapy (BCT), producing dried plasma as a resuscitative product for "traumatic shock." During the 1970s, infectious disease, blood fractionation, and financial opportunities further drove the change from WBT to BCT, with few supporting data. Following a period of high-volume crystalloid and BCT resuscitation well into the early 2000s, measures to avoid the resulting iatrogenic resuscitation injury were developed under the concept of damage control resuscitation. Modern transfusion strategies for hemorrhagic shock target balanced BCT to reapproximate whole blood. Contemporary research has expanded the role of WBT to therapy for the acute coagulopathy of trauma and the damaged endothelium. Many US trauma centers are now using WBT as a front-line treatment in tandem with BCT for patients suffering hemorrhagic shock. Looking ahead, it is likely that WBT will once again be the resuscitative fluid of choice for patients in hemorrhagic shock.

Simplified Blood Transfusion.

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.At one time, blood transfusions were routinely performed only in an operating room (OR). This 1937 article describes how one hospital found a way to change this practice by bringing the OR to the bedside. Author Frances A. Burgess details the contents of the sterile tray and recommends including a second sterile instrument pack in case a "cut down" might be needed for vein access. An OR nurse brings the equipment cart to the ward and assists with the transfusion.Burgess ends her article by emphasizing the benefits of the new protocol, highlighting priorities that will sound familiar to today's hospital nurses. "With this method the operating rooms are not held up by transfusions when as many as seven to nine are given in a day, and ill patients need not be moved to the operating room."For a review of blood products, current recommendations for their use, and the potential complications of transfusions, see "A Review of Current Practice in Transfusion Therapy" in this issue.

Serious hazards of transfusion - conference report: celebration of 20 years of UK haemovigilance.

The Annual SHOT Report for incidents in 2016 was published on July 12 and celebrated of 20 years of UK haemovigilance. Components are very safe, related in part to risk-reduction measures triggered by SHOT reporting. Transfusion-related acute lung injury is now very rare (all plasma components are provided from male donors), and infection transmission is also uncommon - a single transmission of hepatitis E in 2016 and no bacterial transmissions. Human factors (errors) account for 87% of all reports. Deaths and major morbidity most often result from transfusion-associated circulatory overload. Wrong transfusions and deaths from ABO-incompatible transfusion can be reduced by correct bedside checks. It is notable that information technology systems may not be safe. Standardisation is required for flags and alerts. SHOT key recommendations include: assess patients for transfusion-associated circulatory overload prior to transfusion. Be like a pilot - use a bedside checklist when setting up the transfusion.

Blood transfusion during World War I (1914 - 1918).

In august 1914, at the start of World War I, blood transfusion remains quite infrequent, with rough methods, inaccurate indications and poor results. The direct surgical techniques of arteriovenous anastomosis proved ill-adapted to the emergency conditions of war wounds. Indirect techniques with syringes and storage tubes were frequently limited, and complicated, by blood-clotting. Moreover, despite Landsteiner's discovery of ABC blood groups in 1901, compatibility testing was poorly known and often considered unnecessary. At the beginning of the war, none of the belligerent armies'medical services was specifically organized for blood transfusion. In the early years of the war (1914-1916), blood transfusions remain rare. The first transfusion in the French army was performed by Emile Jeanbrau on 16 October 1914. The main impulse, however, came from surgeons of the Canadian Army Medical Corps (CAMC), who had learned about transfusion from doctors in the United States (Bruce Robertson, Edward Archibald). Transfusions became increasingly frequent, particularly as part of pre-operative preparation in cases of wound shock and hemorrhage. The last years (1917-1918) were marked by the arrival of the American Army in France, with a growing medical influence of American doctors. Oswald Robertson introduced the use of citrated blood in glass bottles, being subsequently called "the first blood banker". Blood transfusion remained throughout the war infrequent and technically imperfect. Wartime, however, by the efforts of some young Canadian and American doctors, was a tremendous opportunity for diffusion and improvement.