Ranger O Low Titer (ROLO): Whole Blood Transfusion for Forward Deployed Units

Abstract

First-time use of Ranger O Low Titer (ROLO) blood and implementation of a forward-walking blood bank using predetermined donors proved essential in the survival of a 33-year-old active duty soldier following a complex blast injury during combat operations. The patient sustained significant bone, soft tissue, and vascular damage and continued to deteriorate despite resuscitation with cold-stored whole blood (WB). Only after utilizing the ROLO battle drill and transfusing with fresh WB was the patient able to be stabilized and evacuated. In this case report, we discuss how ROLO walking blood bank takes the next step in aiding resuscitation, providing smaller, forward-deployed units with blood resupply without the administrative burden of storage, particularly in resource-scarce environments. We provide an overview of WB and contrast its use to that of component therapy. In conjunction with the Golden Hour, ROLO can be incorporated as the standard damage control resuscitation to reduce the risks of noncompressible hemorrhage. By taking precautionary steps in the pre-deployment setting, ROLO offers an invaluable alternative to conventional resuscitation.

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

“…Despite this lack of survival benefit in military patients, WB has important logistical advantages as compared with BCT. If platelet stocks are depleted or the logistics are severely hampered, WBB and buddy-to-buddy transfusion providing FWB have shown to be life-saving 75 . If not immediately used, FWB can be stored by refrigeration as a single product containing all required components and has a shelf life of 21 days to 35 days.…”

“…If platelet stocks are depleted or the logistics are severely hampered, WBB and buddy-to-buddy transfusion providing FWB have shown to be life-saving. 75 If not immediately used, FWB can be stored by refrigeration as a single product containing all required components and has a shelf life of 21 days to 35 days. Stored WB has simple cold chain logistics compared with FFP (−30°C) or PLT (20-24°C) and can be stored longer than cold stored thawed plasma or PLT (5-14 days) or room temperature stored PLT (5-7 days).…”

Airborne! UAV delivery of blood products and medical logistics for combat zones

“…While large‐scale prehospital blood transfusion strategies have not been incorporated into the standard military medical doctrine, various US military units and evacuation teams have implemented prehospital whole blood and blood product protocols into their repertoire to aid in patient care. Based on similar strategies from World War II and the Korean War, the US Army's 75th Ranger Regiment developed the Ranger O Low Titer (ROLO) Program aimed to deliver warm fresh low titer type O whole blood to injured personnel at the point of injury 23 . Due to logistical and safety concerns regarding blood product collection in active combat zones, US Special Operations teams began transporting previously collected cold‐stored low titer type O whole blood to high‐risk missions 4 .…”

“…Based on similar strategies from World War II and the Korean War, the US Army's 75th Ranger Regiment developed the Ranger O Low Titer (ROLO) Program aimed to deliver warm fresh low titer type O whole blood to injured personnel at the point of injury. 23 Due to logistical and safety concerns regarding blood product collection in active combat zones, US Special Operations teams began transporting previously collected cold-stored low titer type O whole blood to high-risk missions. 4 This strategy, which allows for up to a 35-day shelf life prior to transfusion, mitigates some of the concerns over rapid product expiration; however, the concerns regarding the labor and resourceintensive nature surrounding prehospital whole blood transfusions persist.…”

Whole blood administration within USCENTCOM

“…From 2004 to 2016, the Joint Trauma System damage control resuscitation clinical practice guideline-recommended blood component therapy with ratios aimed to approximate whole blood, augmented by fresh whole blood collection when the supply of blood components was exhausted, or to address coagulopathy. 3 Experience with warm fresh whole blood as well as retrospective analyses of trauma data suggesting improved survival for whole blood recipients continued to propel the transition to whole blood use. 4,5 Neither warm fresh whole blood nor apheresis platelets collected at deployed locations are Federal Drug Administration (FDA) approved due to the inability to provide the full battery of transfusion-transmitted disease testing on donated units.…”