Tactical damage control resuscitation in austere military environments

Daniel, Yann; Habas, S; Malan, L; Escarment, J.; David, Jean-Stéphane; Peyrefitte, Sébastien

doi:10.1136/jramc-2016-000628

Cited by 38 publications

(27 citation statements)

References 112 publications

(92 reference statements)

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“…Current FMHS guidelines also include on‐site collection of “warm” fresh whole blood from prescreened donors . In our series, this procedure was used in Role 2 MTFs for seven casualties, with blood collection being performed by colocated Role 1 teams.…”

Section: Discussionmentioning

confidence: 99%

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Five years of prolonged field care: prehospital challenges during recent French military operations

et al. 2019

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BACKGROUND French military operations in the Sahel conducted since 2013 over more than 5 million square kilometers have challenged the French Military Health Service with specific problems in prolonged field care. STUDY DESIGN AND METHODS To describe these challenges, we retrospectively analyzed the prehospital data from the first 5 years of these operations within a delimited area. RESULTS One hundred eighty‐three servicemen of different nationalities were evacuated, mainly as a result of explosions (73.2%) or gunshots (21.9%). Their mean number evacuation was 2.2 (minimum, 1; maximum, 8) per medical evacuation with a direct evacuation from the field to a Role 2 medical treatment facility (MTF) for 62% of them. For the highest‐priority casualties (N = 46), the median time [interquartile range] from injury to a Role 2 MTF was 130 minutes [70 minutes to 252 minutes], exceeding 120 minutes in 57% of cases and 240 minutes in 26%. The most frequent out‐of‐hospital medical interventions were external hemostasis, airway and hemopneumothorax management, hypotensive resuscitation, analgesia, immobilization, and antibiotic administration. Prehospital transfusion (RBCs and/or lyophilized plasma) was started three times in the field, two times during helicopter medical evacuation, and five times in tactical fixed wing medical aircraft. Lyophilized plasma was confirmed to be particularly suitable in these settings. One of the specific issues involved in lengthy prehospital time was the importance to reassess and convert tourniquets prior to Role 2 MTF admission. CONCLUSION Main challenges identified include reducing evacuation times as much as possible, preserving ground deployment of sufficiently trained medics and medical teams, optimization of transfusion strategies, and strengthening specific prolonged field care equipment and training.

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Section: Discussionmentioning

confidence: 99%

“…Isolation and longer periods of care in austere settings further strengthen interest in field ultrasound capability to guide diagnosis and intervention. Similarly, it is likely that point‐of‐care laboratory tests (including lactate or coagulation, for example) could help to better guide remote damage control resuscitation …”

Section: Discussionmentioning

confidence: 99%

Five years of prolonged field care: prehospital challenges during recent French military operations

et al. 2019

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“…FWB has been used in military operations, especially in austere or far forward environments (Daniel et al , ), and evidence from the battlefield has shown favourable outcomes when compared to component therapy (Nessen et al , ). The military use an emergency donor panel for collection and delivery of FWB (Strandenes et al , ), and this provides rapid access to warm FWB in the vicinity of the patient, without need for storage, transport or refrigeration.…”

Section: Transfusion and Adjunctive Haemostatic Therapies For Trauma mentioning

confidence: 99%

“…The primary endpoint, 24-h transfusion volume, was not different between arms, although in a subgroup analysis there was significant reduction in transfusion need in patients without traumatic brain injury. FWB has been used in military operations, especially in austere or far forward environments (Daniel et al, 2016), and evidence from the battlefield has shown favourable outcomes when compared to component therapy (Nessen et al, 2013). The military use an emergency donor panel for collection and delivery of FWB , and this provides rapid access to warm FWB in the vicinity of the patient, without need for storage, transport or refrigeration.…”

Section: Whole Bloodmentioning

confidence: 99%

Transfusion strategies for major haemorrhage in trauma

Curry

Davenport

2018

Br J Haematol

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Summary Trauma is a leading cause of death worldwide in persons under 44 years of age, and uncontrolled haemorrhage is the most common preventable cause of death in this patient group. The transfusion management of trauma haemorrhage is unrecognisable from 20 years ago. Changes in clinical practice have been driven primarily by an increased understanding of the pathophysiology of trauma‐induced coagulopathy (TIC), which is associated with poor clinical outcomes, including a 3‐ to 4‐fold increased risk of death. Targeting this coagulopathy alongside changes to surgical and anaesthetic practices (an overarching strategy known as damage control surgery/damage control resuscitation) has led to a significant reduction in mortality rates over the last two decades. This narrative review will discuss the transfusion practices that are currently used for trauma haemorrhage and the evidence that supports these practices.

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“…Bleeding during trauma kills 2 million people each year . Rapid and effective management of hemorrhage is critical to improving patient outcomes, and prevents development of secondary coagulopathies such as hyperfibrinolysis, which occur in many cases of polytrauma and prolonged field care during combat settings . This trauma‐induced coagulopathy is both common, occurring in 25% to 35% of trauma patients, and lethal, accounting for a four‐fold higher mortality rate than in patients without trauma‐induced coagulopathy .…”

Section: Introductionmentioning

confidence: 99%

Topical tranexamic acid inhibits fibrinolysis more effectively when formulated with self‐propelling particles

Baylis

Lee

John

et al. 2019

Journal of Thrombosis and Haemostasis

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Background Endogenous fibrinolytic activation contributes to coagulopathy and mortality after trauma. Administering tranexamic acid (TXA), an antifibrinolytic agent, is one strategy to reduce bleeding; however, it must be given soon after injury to be effective and minimize adverse effects. Administering TXA topically to a wound site would decrease the time to treatment and could enable both local and systemic delivery if a suitable formulation existed to deliver the drug deep into wounds adequately. Objectives To determine whether self‐propelling particles could increase the efficacy of TXA. Methods Using previously developed self‐propelling particles, which consist of calcium carbonate and generate CO2 gas, TXA was formulated to disperse in blood and wounds. The antifibrinolytic properties were assessed in vitro and in a murine tail bleeding assay. Self‐propelled TXA was also tested in a swine model of junctional hemorrhage consisting of femoral arteriotomy without compression. Results Self‐propelled TXA was more effective than non‐propelled formulations in stabilizing clots from lysis in vitro and reducing blood loss in mice. It was well tolerated when administered subcutaneously in mice up to 300 to 1000 mg/kg. When it was incorporated in gauze, four of six pigs treated after a femoral arteriotomy and without compression survived, and systemic concentrations of TXA reached approximately 6 mg/L within the first hour. Conclusions A formulation of TXA that disperses the drug in blood and wounds was effective in several models. It may have several advantages, including supporting local clot stabilization, reducing blood loss from wounds, and providing systemic delivery of TXA. This approach could both improve and simplify prehospital trauma care for penetrating injury.

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Tactical damage control resuscitation in austere military environments

Cited by 38 publications

References 112 publications

Five years of prolonged field care: prehospital challenges during recent French military operations

Five years of prolonged field care: prehospital challenges during recent French military operations

Transfusion strategies for major haemorrhage in trauma

Topical tranexamic acid inhibits fibrinolysis more effectively when formulated with self‐propelling particles

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