The U.S. Armed Services Blood Program support to U.S. Central Command 2014–2021: Transformation of combat trauma resuscitation through blood product innovation and expansion of blood availability far forward

Abstract

Background The United States Armed Services Blood Program (ASBP) faced complex blood supply challenges during two decades of military operations in the U.S. Central Command (CENTCOM) and through an adaptive, responsive, and agile system, gained valuable insights on blood product usage in combat casualty care. Study Design and Methods A retrospective review of blood product introduction and utilization trends was compiled from ASBP data collected during CENTCOM operations from 2014 through 2021. Results During the study period, several blood products were introduced to the CENTCOM area of operations including Low Titer O Whole Blood (LTOWB), Cold‐Stored Platelets (CSP), Liquid Plasma (LP), and French Freeze Dried Plasma (FDP) manufactured from U.S. sourced donor plasma, all while expanding Walking Blood Bank capabilities. There was a gradual substitution of component therapy for whole blood; blood utilization peaked in 2017. Transfusion of Fresh Whole Blood (FWB) from Walking Blood Banks decreased as fully pre‐tested LTOWB was supplied by the ASBP. LTOWB was initially supplied in citrate–phosphate‐dextrose (CPD) anticoagulant (21‐day shelf life) but was largely replaced with LTOWB in citrate–phosphate‐dextrose‐adenine (CPDA‐1) anticoagulant (35‐day shelf life) by 2019. Implementation of prehospital transfusion and expansion of surgical and resuscitation teams led to an increase in the number of sites receiving blood. Discussion ASBP introduced new products to its inventory in order to meet changing blood product demands driven by changes in the Joint Trauma System Clinical Practice Guidelines and operational demands. These products were adopted into clinical practice with a resultant evolution in transfusion strategies.

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

“…(2) Stored WB (SWB); refers to FWB refrigerated at 1°C to 6°C within 8 hours of collection in either citrate-phosphate-dextrose (CPD) (shelf life, 21 days) or citrate-phosphate-dextrose-adenine-1 (CPDA-1) (shelf life, 35 days). 30 (3) Low Titer type O Whole Blood (LTOWB); WB type O with low titer IgM anti-A and anti-B (titer <1:256). 31 Blood component transfusion was defined as red blood cell (RBC) transfusion with or without plasma and/or platelet transfusion.…”

Infectious etiologies among post‐donation deferrals in a military blood donation center

“…Massive hemorrhage has been previously described as the most common preventable cause of death on the battlefield 1 . Military guidelines have since pivoted to prioritize hemorrhage control and pre‐hospital fluid resuscitation 2,3 . While cold‐stored, Food and Drug Administration (FDA)‐compliant whole blood is the preferred product for trauma resuscitation, activation of the walking blood bank (WBB) may be used to obtain fresh whole blood for emergency transfusion when supplies have been depleted.…”

“…1 Military guidelines have since pivoted to prioritize hemorrhage control and pre-hospital fluid resuscitation. 2,3 While cold-stored, Food and Drug Administration (FDA)compliant whole blood is the preferred product for trauma resuscitation, activation of the walking blood bank (WBB) may be used to obtain fresh whole blood for emergency transfusion when supplies have been depleted. However, ensuring the absence of TTIs from WBB products has remained a vexing challenge given the logistical difficulties of meeting FDA standards for testing in the deployed environment.…”

The impact of delivery by a fixed-wing, sling-launched unmanned aerial vehicle on the hematologic function of whole blood

“…Prehospital resuscitation with whole blood is critical in combating morbidity and mortality associated with hemorrhagic shock 1–4 . The military has made great effort to provide early resuscitation with the golden hour, 5,6 low titer group O whole blood (LTOWB), 7,8 and “walking blood bank”/“buddy transfusion” programs 9–12 . Unfortunately, blood still remains scarce in the prehospital setting due primarily to the logistics involved in distribution and delivery to the site of trauma coupled with its perishability.…”

“…[1][2][3][4] The military has made great effort to provide early resuscitation with the golden hour, 5,6 low titer group O whole blood (LTOWB), 7,8 and "walking blood bank"/"buddy transfusion" programs. [9][10][11][12] Unfortunately, blood still remains scarce in the prehospital setting due primarily to the logistics involved in distribution and delivery to the site of trauma coupled with its perishability. Whole blood can be kept in an insulated container for short periods, but longer durations outside of proper refrigeration storage typically means temperature excursions resulting in nonviability of the product.…”