Case Summary
Community Volunteer Fire Department in Houston was dispatched to a high-speed motor vehicle collision and arrived to find an adult patient partially ejected from the passenger side window. The patient was found unresponsive with profound hypotension and agonal respirations and was rapidly moved into the ambulance where resuscitation was initiated.
Initial Presentation
On initial evaluation, the patient demonstrated signs of severe hemorrhagic shock:
- Blood pressure: 41/34 mmHg
- Heart rate: 94 bpm
- Shock index: 2.3
- EtCO₂: 27 mmHg
- Mental status: Unresponsive
No peripheral pulse was detected, and measurable pressure on the monitor was intermittently lost. The patient required assisted ventilation via bag-valve mask due to agonal respirations while bilateral 18-gauge peripheral IV access was established.
Given the severity of hypotension and indicators of impending circulatory collapse, the initiated rapid transfusion using LifeFlow.
LifeFlow was connected to an 18-gauge IV, and two units of whole blood were delivered in approximately seven minutes. The blood was actively warmed using the QinFlow Warrior during infusion.
As the second unit of blood was delivered, 100 mcg of push-dose phenylephrine was administered to support blood pressure in preparation for airway management.
Following blood delivery, the patient demonstrated a marked hemodynamic response:
- Blood pressure: Increased to 101/68 mmHg
- Heart rate: Decreased to 80 bpm
- Shock index: Improved to 0.79
Crews noted a clear transition from losing blood pressure to reliably obtaining a measurable pressure on the monitor. While mentation did not immediately improve, presumably due to the patient’s severe TBI, achieving hemodynamic stability allowed for safer airway management. The patient was successfully intubated to protect the airway prior to transport.
The patient was transferred to Memorial Hermann Life Flight for transport to Memorial Hermann Texas Medical Center for definitive care.
Hospital Course and Outcome
Hospital evaluation revealed a traumatic brain injury without intracranial hemorrhage, extensive spinal injuries including a C3 burst fracture with epidural hematoma, C5 vertebral body fracture, and L4 burst fracture with canal stenosis, as well as significant thoracoabdominal trauma including right hemothorax, bilateral pulmonary contusions, multiple rib fractures, right diaphragmatic injury, expanding retroperitoneal hematomas, and right renal hilar bleeding. He underwent emergent exploratory laparotomy, clamshell thoracotomy with right lower lobectomy, right nephrectomy, diaphragm repair, and multiple re-explorations for hemorrhage and compartment management. Due to the severity of the initial presentation, the patient was placed on venovenous ECMO for refractory hypoxemia.
The patient was successfully decannulated from both ECMO and tracheostomy. After a four-month hospital course, he was discharged neurologically intact.
Clinician Perspective
According to the EMS crew, the most significant impact of LifeFlow was the speed of whole blood delivery:
“Our ability to deliver two units of blood within seven minutes made a significant impact on patient care. We went from losing the blood pressure to getting one back very quickly—which ultimately saved this patient.”
The crew also emphasized the simplicity of setup and ease of use, particularly in a high-stress, time-critical environment.
Takeaway
This case highlights how rapid, prehospital whole blood delivery can restore perfusion in patients with severe hemorrhagic shock when every minute matters. LifeFlow provided rapid, controlled transfusion through peripheral IV access, helping crews quickly reestablish circulation and buy the time needed to secure the airway, move the patient, and deliver definitive care.