Hemorrhagic shock following penetrating trauma is associated with high mortality and requires immediate resuscitation with blood products. Traditional rapid infusion methods used for massive transfusion protocols (MTP) are often complex and unreliable, limiting the effectiveness of resuscitation in the crucial early minutes of care. The following case illustrates how the LifeFlow rapid infuser and QinFlow Warrior warmer can be used to provide rapid, warmed blood transfusion for immediate stabilization of a critically injured patient before transfer to a higher level of care.
Case Presentation
A 60-year-old patient presented to a critical access hospital emergency department (ED) following a gunshot wound to the chest. The patient was unstable on arrival, with signs of profound hemorrhagic shock and significantly altered level of consciousness. The EMS team established vascular access and had begun infusing by pressure bag.
Management
Initial vital signs on ED arrival included a blood pressure of 57/35 mmHg, heart rate of 123 bpm, and a GCS score of less than 8. The patient was intubated immediately upon arrival and the MTP was activated.
After establishing a second 18G peripheral IV, the ED team initiated resuscitation using the LifeFlow rapid infuser and QinFlow Warrior blood warmer. While awaiting the arrival of blood products, a 1-liter fluid bolus was delivered in approximately 3 minutes. This was followed by 4 units of packed red blood cells (PRBCs), and 2 units of fresh frozen plasma (FFP), each administered via LifeFlow in 1 to 1½ minutes. Simultaneously, the EMS-placed line continued infusing via pressure bag as an additional access point.
Following resuscitation, the patient’s hemodynamics improved substantially with a blood pressure of 100/65 mmHg and heart rate decreased to 119 bpm. Once stabilized, the patient was transferred to a tertiary care center where he survived.
Discussion
This case represents the team’s first activation of a full MTP protocol using LifeFlow with the QinFlow Warrior. The Trauma Coordinator reported that the pressure bag running concurrently on the EMS line took three times as long to infuse — and ultimately left approximately 300 mL undelivered, as fluid pooled at the top of the bag.
The care team noted that this was the fastest blood administration they had ever performed during an MTP. A post-resuscitation debrief highlighted a significant contrast between the team’s perceived infusion time and the actual clock time, noting that this was “the fastest we’ve ever gotten that much blood in!”
The process of running an MTP with LifeFlow was described as smooth and effective. The combination of LifeFlow and the QinFlow Warrior allowed staff to deliver warmed blood products rapidly through a single peripheral IV without the delays or complexity associated with traditional pressure bag or rapid infuser methods.
In penetrating trauma with hemorrhagic shock, time to resuscitation directly impacts patient survival. This case demonstrates that LifeFlow paired with QinFlow Warrior can enable ED teams to execute an MTP quickly and confidently, through a PIV and without the need for central access, making the most of every minute and giving critically injured patients the best possible chance for survival.