Whole blood transfusion closest to the point-of-injury during French remote military operations (original) (raw)
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Constant challenges and evolution of US military transfusion medicine and blood operations in combat
Transfusion, 2012
BACKGROUND: Blood operations are constrained by many limitations in combat settings. As a result there are many challenges that require innovative solutions. STUDY DESIGN AND METHODS: This is a descriptive overview of blood product usage and transfusion medicine adaptations that have been employed by the US military to support combat operations in Iraq and Afghanistan between November 2001 and December 2010. RESULTS: Transfusion medicine challenges have included the need for rapid transport of large quantities of blood products from the United States to Iraq and Afghanistan, risks and appropriate countermeasures associated with blood products collected in the theater of operations, availability of fresh-frozen plasma at forward surgical facilities, need for platelets (PLTs) in combat, and the need to support constant and evolving changes in transfusion and resuscitation protocols. A decrease in the storage age of red blood cells (RBCs) transfused to combat casualties has been achieved. There has been an increase in the ratio of plasma and PLTs to RBCs transfused, increased availability of plasma and apheresis PLTs to facilitate this approach, and a continuous effort to improve the safety of using fresh whole blood and apheresis PLTs collected in combat. A number of clinical practice guidelines are in place to address these processes. CONCLUSION: This multidisciplinary approach has successfully addressed many complicated and challenging issues regarding blood operations and transfusion practices for combat casualties. ABBREVIATIONS: ASWBPL = Armed Services Whole Blood Processing Laboratory; CENTCOM = Central Command; MTF(s) = medical treatment facility (-ies); WWI (-II) = World War I (II).
Fresh Whole Blood Transfusion: A Controversial Military Practice
The Journal of Trauma: Injury, Infection, and Critical Care, 2006
The transfusion of fresh whole blood (FWB) for trauma-induced coagulopathy is unusual in civilian practice. However, US military physicians have used FWB in every combat operation since the practice was introduced in World War I and continue to do so during current military operations. We discuss our review of all blood products administered to US military casualties in Operation Iraqi Freedom (OIF) between March and December 2003. FWB transfusions were most frequent when demands for massive transfusions wiped out existing blood supplies. FWB patients had the highest blood product requirements; however, mortality did not differ significantly between FWB and non-FWB patients overall or for massively transfused patients. We review the current military practice of FWB transfusion in combat theaters and conclude that FWB transfusion is convenient, safe, and effective in certain military situations.
Fresh whole blood transfusion capability for Special Operations Forces
Canadian journal of surgery. Journal canadien de chirurgie, 2015
Fresh whole blood (FWB) transfusion is an option for providing volume and oxygen carrying capacity to bleeding Special Operations soldiers who are injured in an austere environment and who are far from a regular blood bank. Retrospective data from recent conflicts in Iraq and Afghanistan show an association between the use of FWB and survival. We reviewed the literature to document the issues surrounding FWB transfusion to Special Operations soldiers in the austere environment and surveyed the literature regarding best practice guidelines for and patient outcomes after FWB transfusions. Most literature regarding FWB transfusion is retrospective or historical. There is limited prospective evidence currently to change transfusion practice in tertiary care facilities, but FWB remains an option in the austere setting.
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2010
The leading cause of death on the battlefield is uncontrolled hemorrhage. Non-compressible (truncal) hemorrhage is the cause over two thirds of these deaths. This makes truncal hemorrhage the leading cause of potentially survivable death on the battlefield. Over one third of the casualties who arrive at the emergency department (ED) or combat surgical hospital (CSH) in need of a blood transfusion are already suffering from acute traumatic coagulopathy which is associated with an 80% mortality. Early aggressive treatment and prevention of this coagulopathy through hemostatic resuscitation has been shown to increase survival. Hemostatic resuscitation involves the very early use of blood and blood products as primary resuscitation fluids to both treat intrinsic acute traumatic coagulopathy and prevent the development of dilutional coagulopathy. Few, if any, of the products used in hemostatic resuscitation are currently available to the Special Operations Forces (SOF) medic. Warm fresh ...
Emergency Whole-Blood Use in the Field
Shock, 2014
Military experience and recent in-vitro laboratory data provide a biological rationale for whole blood use in the treatment of exsanguinating hemorrhage and have renewed interest in the re-introduction of fresh whole blood(FWB) and cold stored Whole Blood(WB) to patient care in austere environments. There is scant evidence to support, in a field environment, that a whole blood based resuscitation strategy is superior to a crystalloid/colloid approach even when augmented by a limited number of RBC and plasma units. Recent retrospective evidence suggests that in this setting resuscitation with a full compliment of RBCs, plasma, and platelets may offer an advantage, especially under conditions where evacuation is delayed. No current evacuation system, military or civilian, is capable of providing RBC, plasma and platelet units in a pre-hospital environment, especially in austere settings. As a result, for the vast minority of casualties, in austere settings, with life-threatening hemorrhage, it is appropriate to consider a whole blood-based resuscitation approach to provide a balanced response to altered hemostasis and oxygen debt with the goal of reducing the risk of death from hemorrhagic shock. To optimize the successful use of FWB/WB in combat field environments, proper planning and frequent training to maximize efficiency and safety will be required. Combat medics will need proper protocol-based guidance, and education if whole blood collection and transfusion are to be successfully and safely performed in austere environments. In this manuscript, we present the Norwegian Naval Special Operation Commando's unit-specific RDCR protocol, which includes field collection and transfusion of whole blood. This protocol can serve as a template for others to use and adjust for their own military or civilian unitspecific needs and capabilities for care in austere environments.
Transfusion practice in military trauma
Transfusion Medicine, 2008
Modern warfare causes severe injuries, and despite rapid transportation to theater regional trauma centers, casualties frequently arrive coagulopathic and in shock. Conventional resuscitation beginning with crystalloid fluids to treat shock causes further dilutional coagulopathy and increased hemorrhagic loss of platelets and coagulation factors. Established coagulopathy was difficult to reverse in the face of uncontrolled hemorrhage. Because many of the casualties met conventional plasma and platelet transfusion criteria on admission, thawed AB plasma was prepositioned in the trauma receiving area and used in a 1:1 ratio with red cells for resuscitation and fresh whole blood was used as a source of platelets. Retrospective assessments of this 1:1 therapy strongly suggested that it resulted in improved hemostasis, shorter ventilator times, and improved survival. Component therapy, when available, appears to be as effective as fresh whole blood. In field emergencies, fresh whole blood can be lifesaving.
The implementation of a multinational “walking blood bank” in a combat zone
Journal of Trauma and Acute Care Surgery, 2015
BACKGROUND: We present here a description of the experience in whole-blood transfusion of a health service team deployed to a medical treatment facility in Afghanistan from June 2011 to October 2011. The aim of our work was to show how a ''walking blood bank'' could provide a sufficient supply. METHODS: We gathered the blood-group types of military personnel deployed to the theater of operations to evaluate our ''potential walking blood bank,'' and we compared these data with our needs. RESULTS: Blood type frequencies among our ''potential walking blood bank'' were similar to those observed in European or American countries. Our resources could have been limited because of a low frequency of B blood type and negative rhesus in our ''potential walking blood bank.'' Because of the large number of potential donors in the theater of operations, the risk of blood shortage was quite low and we did not face blood shortage despite significant transfusion requirements. Actually, 93 blood bags were collected, including rare blood types like AB and B blood types. CONCLUSION: In our experience, this international ''walking blood bank'' provided a quick, safe, and sufficient blood supply. More research in this area is needed, and our results should be confirmed by further prospective trials.
2008
Medical care in modern warfare is challenged by the use of high-explosive weapons that can induce mass casualties. In the current conflicts, improvements in body armour, the use of tourniquets and hemostatic dressings and in most cases, rapid evacuation times has resulted in higher survival rates than seen in prior wars. A major medical advance in the current conflicts is the initiation of damage control resuscitation for the treatment of severely injured Soldiers, particularly those who require massive transfusion and have dysfunction of their blood clotting system and the highest risk of dying. Recent retrospective analysis of traumatic injuries has revealed that patients who received plasma or a plasma to RBC ratio close to 1:1, had improved survival compared to patients who received standard transfusion therapy of plasma to RBC ratios of 1:4 or greater. As further analysis of the benefits of plasma are realized, research efforts in the laboratory are investigating and characterizing a freeze-dried plasma compared to standard fresh frozen plasma, so the benefits of this blood product can be delivered to far forward locations for the early treatment of severely injured Soldiers. 14. ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT UU 18. NUMBER OF PAGES 7 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18