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Original research
Is the whole greater than the sum of its parts? The implementation and outcomes of a whole blood program in Ecuador
  1. Amber Himmler1,
  2. Monica Eulalia Galarza Armijos2,3,
  3. Jeovanni Reinoso Naranjo2,3,
  4. Sandra Gioconda Peña Patiño3,
  5. Doris Sarmiento Altamirano4,5,
  6. Nube Flores Lazo2,3,
  7. Raul Pino Andrade2,3,
  8. Hernán Sacoto Aguilar2,6,
  9. Lenin Fernández de Córdova2,7,
  10. Cecibel Cevallos Augurto2,3,
  11. Nakul Raykar8,
  12. Juan Carlos Puyana9,
  13. Juan Carlos Salamea2,6
  1. 1Department of Surgery, MedStar Georgetown University Hospital, Washington DC, District of Columbia, USA
  2. 2Department of Surgery, Hospital Vicente Corral Moscoso Cuenca, Cuenca, Ecuador
  3. 3College of Medicine, Universidad de Cuenca, Cuenca, Ecuador
  4. 4College of Medicine, University of Azuay, Cuenca, Ecuador
  5. 5Department of Surgery, Hospital Jose Carrasco Arteaga, Cuenca, Ecuador
  6. 6College of Medicine, Universidad de Azuay, Cuenca, Ecuador
  7. 7College of Medicine, Universidad Católica de Cuenca, Cuenca, Ecuador
  8. 8Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  9. 9Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Amber Himmler, Department of Surgery, Washington, 20010, USA; amberhimmler{at}gmail.com

Abstract

Background Hemorrhagic shock is a major cause of mortality in low-income and middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood (WB) program in Latin America and to discuss the outcomes of the patients who received WB.

Methods We conducted a retrospective review of patients resuscitated with WB from 2013 to 2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, shock index, Revised Trauma Score in trauma patients, intraoperative crystalloid (lactated Ringer’s or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length of stay, and in-hospital mortality.

Results The sample includes a total of 101 patients, 57 of which were trauma and acute care surgery patients and 44 of which were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. The average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of WB. Overall mortality was 13.86% (14 of 101) in the first 24 hours and 5.94% (6 of 101) after 24 hours.

Discussion Implementing a WB protocol is achievable in LMICs. WB allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a WB program implemented in a civilian hospital in Latin America.

Level of evidence Level IV.

  • global surgery
  • whole blood
  • hemorrhage
  • shock

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2021-000758

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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    Footnotes

    • Contributors Data collection, data analysis, article writing: AH. Data collection, article writing: MEGA. Data collection, data analysis: JRN, DSA, SGPP. Critical review of the article: NFL, RPA, HSA, LFdC, CCA. Critical review of the article, final approval of the article for submission: JCP, JCS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.