Emergency Whole-Blood Use in the Field

Abstract

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 reintroduction of fresh whole blood and cold-stored whole blood 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 red blood cell (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 prehospital 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 fresh whole blood/cold-stored whole blood 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 article, we present the Norwegian Naval Special Operation Commando unit-specific remote damage control resuscitation 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 unit-specific needs and capabilities for care in austere environments.

Blood transfusion for deep space exploration

“…Fresh whole blood is effective in situations of life‐threatening hemorrhage. It helps maintain tissue oxygenation, prevents coagulopathy, hypothermia, and acidosis, and does not cause the dilution seen with crystalloids and component therapy . Whole blood carries an increased risk for infectious disease transmission which is mitigated with donor screening.…”

“…Whole blood carries an increased risk for infectious disease transmission which is mitigated with donor screening. There is also a theoretical concern for transfusion reactions and graft versus host disease, though this has not been consistently demonstrated . An overview of blood product characteristics is shown in Table .…”

“…Terrestrially, isotonic crystalloids are commonly used in traumatic resuscitation because of their wide availability, reasonable shelf life, and uncomplicated storage requirements . The only resuscitation fluids available on the International Space Station (ISS) are four liters of normal saline, and methods to generate crystalloids in flight are under investigation .…”

Hemorrhagic blood failure

“…The “walking blood bank” concept is advantageous because it appears to be technically feasible and reduces the need for prolonged blood transport and storage in austere settings (98). In addition, cold stored leukoreduced whole blood was found to retain its hemostatic function after 14 days of austere storage aboard a naval vessel comparably to components containing 5-day warm stored platelets (99).…”

The school of hard knocks: what we've learned and relearned about transfusion in a decade of global conflict

“…The planners for the London Olympics are to be commended for creating contingency donor panels, and this could serve as the basis for a new model in civilian MCE planning. Given that early resuscitation with blood is associated with improved outcomes and that the chaos generated by civilian emergencies such as terrorist attacks would likely sow panic and create traffic conditions that might preclude timely resupply to overwhelmed hospitals closest to event epicentres, the ability to call on pedigreed donors at hand could present the only viable option for augmenting rapidly depleting blood supplies (Holcomb et al, 2008;Cap et al, 2012;Strandenes et al, 2014). The simplicity of whole blood offers major advantages in trauma resuscitation.…”