The implementation of a multinational “walking blood bank” in a combat zone

Hejl, Connie; Martinaud, Christophe; Macarez, R.; Sill, Joshua; Golvan, Armelle Le; Dulou, R.; Roche, C.; Rudnicki, S. de

doi:10.1097/ta.0000000000000618

Cited by 30 publications

(7 citation statements)

References 18 publications

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“…We identified 17 studies reporting about patients with traumatic hemorrhage treated with at least 1 unit WB (without BCT comparison) including 10 retrospective cohort studies, 4 case series, and 3 prospective observational studies 12,14,58–72 . All studies are summarized in Supplementary Digital Content 13, http://links.lww.com/TA/D6.…”

Section: Resultsmentioning

confidence: 99%

“…We identified 17 studies reporting about patients with traumatic hemorrhage treated with at least 1 unit WB (without BCT comparison) including 10 retrospective cohort studies, 4 case series, and 3 prospective observational studies. 12,14,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] All studies are summarized in Supplementary Digital Content 13, http://links.lww.com/TA/D6. In brief, included studies reported that WB transfusion is feasible in both military medicine, 62,68 and civilian medicine, 12,70,71 including in the prehospital setting.…”

Section: Wb Transfusion Without Bct Comparisonmentioning

confidence: 99%

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Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Horst

Rijnhout

Noorman³

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Whole blood (WB) transfusion received renewed interest after recent armed conflicts. The effectiveness as compared with blood component transfusion (BCT) is, however, still topic of debate. Therefore, this study investigated the effect of WB ± BCT as compared with BCT transfusion on survival in trauma patients with acute hemorrhage. METHODS Studies published up to January 16, 2023, including patients with traumatic hemorrhage comparing WB ± BCT and BCT were included in meta-analysis. Subanalyses were performed on the effectiveness of WB in the treatment of civilian or military trauma patients, patients with massive hemorrhage and on platelet (PLT)/red blood cell (RBC), plasma/RBC and WB/RBC ratios. Methodological quality of studies was interpreted using the Cochrane risk of bias tool. The study protocol was registered in PROSPERO under number CRD42022296900. RESULTS Random effect pooled odds ratio (OR) for 24 hours mortality in civilian and military patients treated with WB as compared with BCT was 0.72 (95% confidence interval [CI], 0.53–0.97). In subanalysis of studies conducted in civilian setting (n = 20), early (4 hours, 6 hours, and emergency department) and 24 hours mortality was lower in WB groups compared with BCT groups (OR, 0.65; 95% CI, 0.44–0.96 and OR, 0.71; 95% CI, 0.52–0.98). No difference in late mortality (28 days, 30 days, in-hospital) was found. In military settings (n = 7), there was no difference in early, 24 hours, or late mortality between groups. The WB groups received significant higher PLT/RBC (p = 0.030) during early treatment and significant higher PLT/RBC and plasma/RBC ratios during 24 hours of treatment (p = 0.031 and p = 0.007). The overall risk of bias in the majority of studies was judged as serious due to serious risk on confounding and selection bias, and unclear information regarding cointerventions. CONCLUSION Civilian trauma patients with acute traumatic hemorrhage treated with WB ± BCT as compared to BCT had lower odds on early and 24-hour mortality. In addition, WB transfusion resulted in higher PLT/RBC and plasma/RBC ratios. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis; Level III.

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“…We identified 17 studies reporting about patients with traumatic hemorrhage treated with at least 1 unit WB (without BCT comparison) including 10 retrospective cohort studies, 4 case series, and 3 prospective observational studies 12,14,58–72 . All studies are summarized in Supplementary Digital Content 13, http://links.lww.com/TA/D6.…”

Section: Resultsmentioning

confidence: 99%

“…We identified 17 studies reporting about patients with traumatic hemorrhage treated with at least 1 unit WB (without BCT comparison) including 10 retrospective cohort studies, 4 case series, and 3 prospective observational studies. 12,14,[58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] All studies are summarized in Supplementary Digital Content 13, http://links.lww.com/TA/D6. In brief, included studies reported that WB transfusion is feasible in both military medicine, 62,68 and civilian medicine, 12,70,71 including in the prehospital setting.…”

Section: Wb Transfusion Without Bct Comparisonmentioning

confidence: 99%

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Horst

Rijnhout

Noorman³

et al. 2023

J Trauma Acute Care Surg

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“…As prehospital transfusion practices continue to advance across the globe, the face of resuscitation for patients in hemorrhagic shock also continues to evolve. 9,13 The recent addition of whole blood in trauma resuscitation algorithms has led to the potential for improved survival in civilians. For severely injured patients, earlier reversal of shock physiology has the potential benefit to improve both short-and long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…8 Beyond the US Military, whole blood use has become a multinational practice with wartime collaboration and development of civilian whole programs around the world. 9 In civilian prehospital resuscitation, previous studies focused on the impact of prehospital plasma on patients in hemorrhagic shock secondary to trauma. 10 Few studies have specifically addressed the use of whole blood in the civilian prehospital setting.…”

Section: Introductionmentioning

confidence: 99%

Prehospital whole blood reduces early mortality in patients with hemorrhagic shock

et al. 2021

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Background Low titer O+ whole blood (LTOWB) is being increasingly used for resuscitation of hemorrhagic shock in military and civilian settings. The objective of this study was to identify the impact of prehospital LTOWB on survival for patients in shock receiving prehospital LTOWB transfusion. Study design and methods A single institutional trauma registry was queried for patients undergoing prehospital transfusion between 2015 and 2019. Patients were stratified based on prehospital LTOWB transfusion (PHT) or no prehospital transfusion (NT). Outcomes measured included emergency department (ED), 6‐h and hospital mortality, change in shock index (SI), and incidence of massive transfusion. Statistical analyses were performed. Results A total of 538 patients met inclusion criteria. Patients undergoing PHT had worse shock physiology (median SI 1.25 vs. 0.95, p < .001) with greater reversal of shock upon arrival (−0.28 vs. −0.002, p < .001). In a propensity‐matched group of 214 patients with prehospital shock, 58 patients underwent PHT and 156 did not. Demographics were similar between the groups. Mean improvement in SI between scene and ED was greatest for patients in the PHT group with a lower trauma bay mortality (0% vs. 7%, p = .04). No survival benefit for patients in prehospital cardiac arrest receiving LTOWB was found (p > .05). Discussion This study demonstrated that trauma patients who received prehospital LTOWB transfusion had a greater improvement in SI and a reduction in early mortality. Patient with prehospital cardiac arrest did not have an improvement in survival. These findings support LTOWB use in the prehospital setting. Further multi‐institutional prospective studies are needed.

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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%

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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The implementation of a multinational “walking blood bank” in a combat zone

Abstract: Therapeutic study, level V.

Cited by 30 publications

References 18 publications

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis

Prehospital whole blood reduces early mortality in patients with hemorrhagic shock

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

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