Impact of Policy Change on US Army Combat Transfusion Practices

Simmons, John W.; White, Christopher E.; Eastridge, Brian J.; Mace, James E.; Wade, Charles E.; Blackbourne, Lorne H.

doi:10.1097/ta.0b013e3181e44952

Cited by 52 publications

(70 citation statements)

References 26 publications

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“…This change was driven by multiple studies describing a continued improvement in clinical outcomes using the Joint Theater Trauma Registry. 5 The concept of DCR and the administration of a balanced ratio of blood products have been expanded to the prehospital arena, where thawed plasma, RBCs, and tranexamic acid on helicopters are used to resuscitate casualties. 10 Dried plasma is currently carried by medics for Special Operations Forces in Afghanistan.…”

mentioning

confidence: 99%

“…8,9 By 2010, essentially 100% of massive transfusions administered in the combat theater were balanced in a 1:1:1 (plasma:platelet:RBC) ratio. 5 The DCR concept advocated decreasing crystalloid use to a minimum and using blood products as the primary resuscitative fluid. This change was driven by multiple studies describing a continued improvement in clinical outcomes using the Joint Theater Trauma Registry.…”

mentioning

confidence: 99%

“…5 In 2001, the military transfusion practice mimicked the standard civilian approach, in which crystalloid was administered first, followed by RBCs, then plasma, and rarely platelets and cryoprecipitate. By 2005, a change had already occurred, revealed in the publication by Borgman et al describing the survival advantage of the 1:1 plasma and RBC ratio, a balanced transfusion concept described as "Damage Control Resuscitation (DCR)."…”

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confidence: 99%

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Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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confidence: 99%

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confidence: 99%

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Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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“…Simmons ve ark. nın [14] çalışmasındaki olguların yaş ortalaması 25 olarak bildirilmiştir. Köksal ve ark.nın [15] Uludağ Üniversitesi'nde yaptıkları araştırmaya göre beş yıllık YKE silah yaralanmalı olgu sayıları 135'tir.…”

Section: Bulgularunclassified

“…Simmons ve ark.nın [14] çalışmalarında transfüzyon uygulaması gerçekleştirdikleri olguların ISS değerlerinin ortalaması olarak 24 ve 25 değerlerini bildirmişlerdir. Eastridge ve ark.…”

Section: Bulgularunclassified

The relationship between Injury Severity Scores and transfusion requirements of 108 consecutive cases injured with high kinetic energy weapons: a tertiary center end-mode mortality analysis

Eryılmaz¹,

Tezel²,

Taş³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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ÖZET AMAÇ: Çalışmamızda yüksek kinetik enerjili silahla yaralanmış olgulara ait ISS değerlerinin tıbbi müdahaleleri süresince gereksinim duyulan transfüzyon stratejileri ile ilişkisini ve son mod mortalite analizlerini gerçekleştirmeyi amaçladık. GEREÇ VE YÖNTEM:Olgulara ait tıbbi veriler çalışmaya dahil edildi. Olguların demografik özellikleri, yüksek kinetik enerjili silah türü, yaralanma şiddet skorları (Injury Severity Score, ISS), transfüzyon strateji seçenekleri, transfüzyon gereksinimi olan ve olmayan olguların ISS değerleri açısından anlamlı bir korelasyon olup olmadığı analiz edildi. Hospitalizasyon sürecinde mortalite ile sonuçlanan olgulara ait nedenler ait değerlendirildi. BULGULAR:Yüz sekiz ardışık olgu çalışmaya dahil edildi. Yaş ortalaması 25 olan olguların biri dışında tamamı erkek idi. Olguların %64.8'inin uzun namlulu ateşli silahlar, %35.2'sinin patlayıcılar ile yaralandığı tespit edildi. Ortalama ISS değeri 13.9 saptandı. Transfüzyon uygulanan gruptaki olguların ISS değeri: 16 (median 5-48), uygulanmayan gruptaki olguların ISS değeri ise 9 (median 3-36) olarak saptandı. Hospitalizasyon sürecinde mortalite ile sonuçlanan üç olguya ait nedenler; SIRS, MODS ve sepsis açısından irdelendi. SONUÇ:Yüksek kinetik enerjili silah yaralılarında ISS değeri yükseldikçe olguların transfüzyon gereksinimleri arasında korelasyon bulunduğu, patlayıcılarla yaralananlarda ise bu gereksinimin ISS değerinden bağımsız olduğu tespit edildi.Anahtar sözcükler: Ateşli silah yaralanması; mortalite; transfüzyon; yaralanma hasar skoru.

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