PT - JOURNAL ARTICLE AU - Amber Himmler AU - Monica Eulalia Galarza Armijos AU - Jeovanni Reinoso Naranjo AU - Sandra Gioconda Peña Patiño AU - Doris Sarmiento Altamirano AU - Nube Flores Lazo AU - Raul Pino Andrade AU - Hernán Sacoto Aguilar AU - Lenin Fernández de Córdova AU - Cecibel Cevallos Augurto AU - Nakul Raykar AU - Juan Carlos Puyana AU - Juan Carlos Salamea TI - Is the whole greater than the sum of its parts? The implementation and outcomes of a whole blood program in Ecuador AID - 10.1136/tsaco-2021-000758 DP - 2021 Nov 01 TA - Trauma Surgery & Acute Care Open PG - e000758 VI - 6 IP - 1 4099 - http://tsaco.bmj.com/content/6/1/e000758.short 4100 - http://tsaco.bmj.com/content/6/1/e000758.full SO - Trauma Surg Acute Care Open2021 Nov 01; 6 AB - 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.Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.