Blood use in war and disaster: lessons from the past century

Hess, John R.; Thomas, Moira

doi:10.1046/j.1537-2995.2003.00576.x

Cited by 173 publications

(142 citation statements)

References 24 publications

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“…20 Every US military operation in the past 100 years has used FWB for resuscitation after hemorrhage. 24 Table 1 25 According to a DoDTR query by the authors, a total of 1607 units of FWB were used in Afghanistan from 2010 to 2013 (Figure 1). A comparison of the use of FWB and blood components ( Figure 2) indicates that although FWB use is lower than RBC use from 2010 through 2013, FWB is consistently used in military trauma resuscitation.…”

Section: Fresh Whole Blood: Forward Deployed Settingsmentioning

confidence: 99%

Fresh Whole Blood Transfusion: Military and Civilian Implications

Goforth

Tranberg

Boyer³

et al. 2016

Critical Care Nurse

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Uncontrolled hemorrhage and exsanguination are the leading cause of preventable death, and resuscitative therapy is a critical component for survival. In various combinations, fresh whole blood, blood components, colloids, and crystalloids have all been staples of trauma care. The use of fresh whole blood is a well-established military practice that has saved the lives of thousands of American and coalition military personnel. Civilian use of fresh whole blood is far less established owing to the wide availability of individual blood components. However, this highly tailored blood supply is vulnerable to both natural and man-made disasters. In the event of such disruption, such as a major hurricane, it may be necessary for civilian hospitals to rapidly enact a fresh whole blood program. Therefore, the aim of this article is to review the current use of blood therapy for trauma resuscitation, the US military's approach to fresh whole blood, and how maintaining a civilian capacity for fresh whole blood collection in the event of future man-made and natural disasters is key to promoting survival from trauma. (Critical Care Nurse. 2016; 36[3] 1 Hemorrhage, in turn, quickly leads to hypoperfusion, or "shock," and coagulopathy.2 Death due to hemorrhage occurs soon after trauma, usually within the first 6 hours of hospital admission.3,4 US hospital data on trauma patients indicates that coagulopathy, which is associated with early mortality, occurs in 28% of hospital admissions.5 Determining which patients are at risk of shock and coagulopathy developing and applying resuscitation strategies to prevent these processes directly improve survival. 6 In various combinations, fresh whole blood (FWB), blood component therapy (BCT), colloids, and crystalloids have all been staples of trauma care. Therefore, our aim is to review the current use of blood therapy for trauma resuscitation and the US military's approach to FWB. This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Compare and contrast the evidence regarding the transfusion of fresh whole blood 2. Describe the application of fresh whole blood transfusion in the event of a man-made or natural disaster 3. Describe the steps and supplies necessary for the safe collection of fresh whole blood To complete evaluation for CE contact hour(s) for test #C163, visit www.ccnonline.org and click the "CE Articles" button. No CE test fee for AACN members.

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Section: Fresh Whole Blood: Forward Deployed Settingsmentioning

confidence: 99%

Fresh Whole Blood Transfusion: Military and Civilian Implications

Goforth

Tranberg

Boyer³

et al. 2016

Critical Care Nurse

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“…By March 1945, the army was shipping 2000 units a day (Figs. 9, 10) [68]. The system was implemented rapidly, was highly efficient, and doubtless saved thousands of lives but was completely dismantled by the onset of the Korean War.…”

Section: Blood Transfusionmentioning

confidence: 99%

Treatment of War Wounds: A Historical Review

Manring

Hawk

Calhoun

et al. 2009

Clinical Orthopaedics &Amp; Related Research

144

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The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

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“…Costly diagnostics and handling regulations, increasingly stringent donor deferral criteria, and a lack of blood donors partly explain this problem (17,51,70,161). However, other issues, including emergent pathogens and natural disasters are of concern (1,24,25,32,34,50,59,60,89,128,141,161). Disease transmission and adverse reactions from misstransfusions remain problematic even with best practices in place (30,103,129,133,161).…”

mentioning

confidence: 99%

Development of Recombinant Hemoglobin-Based Oxygen Carriers

Varnado

Mollan

Birukou

et al. 2013

Antioxidants & Redox Signaling

102

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Significance: The worldwide blood shortage has generated a significant demand for alternatives to whole blood and packed red blood cells for use in transfusion therapy. One such alternative involves the use of acellular recombinant hemoglobin (Hb) as an oxygen carrier. Recent Advances: Large amounts of recombinant human Hb can be expressed and purified from transgenic Escherichia coli. The physiological suitability of this material can be enhanced using protein-engineering strategies to address specific efficacy and toxicity issues. Mutagenesis of Hb can (i) adjust dioxygen affinity over a 100-fold range, (ii) reduce nitric oxide (NO) scavenging over 30-fold without compromising dioxygen binding, (iii) slow the rate of autooxidation, (iv) slow the rate of hemin loss, (v) impede subunit dissociation, and (vi) diminish irreversible subunit denaturation. Recombinant Hb production is potentially unlimited and readily subjected to current good manufacturing practices, but may be restricted by cost. Acellular Hb-based O 2 carriers have superior shelf-life compared to red blood cells, are universally compatible, and provide an alternative for patients for whom no other alternative blood products are available or acceptable. Critical Issues: Remaining objectives include increasing Hb stability, mitigating iron-catalyzed and iron-centered oxidative reactivity, lowering the rate of hemin loss, and lowering the costs of expression and purification. Although many mutations and chemical modifications have been proposed to address these issues, the precise ensemble of mutations has not yet been identified. Future Directions: Future studies are aimed at selecting various combinations of mutations that can reduce NO scavenging, autooxidation, oxidative degradation, and denaturation without compromising O 2 delivery, and then investigating their suitability and safety in vivo. Antioxid. Redox Signal. 18, 2314-2328.

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Blood use in war and disaster: lessons from the past century

Cited by 173 publications

References 24 publications

Fresh Whole Blood Transfusion: Military and Civilian Implications

Fresh Whole Blood Transfusion: Military and Civilian Implications

Treatment of War Wounds: A Historical Review

Development of Recombinant Hemoglobin-Based Oxygen Carriers

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