The safety of early fresh, whole blood transfusion among severely battle injured at US Marine Corps forward surgical care facilities in Afghanistan

Auten, Jonathan D.; Lunceford, Nicole L; Horton, Jaime L.; Galarneau, Michael R.; Galindo, Roger M; Shepps, Craig; Zieber, Tara J.; Dewing, Chris B.

doi:10.1097/ta.0000000000000842

Cited by 42 publications

(32 citation statements)

References 22 publications

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“…The studies conducted in the military setting included Auten et al, 24 Keneally et al, 25 Nessen et al, 26 Perkins et al, 27 and Spinella et al 28 . Auten et al, 24 Keneally et al, 25 Nessen et al, 26 and Spinella et al 28 . reported on the use of either fresh whole blood or warm fresh whole blood in combination with component therapy as an intervention.…”

Section: Resultsmentioning

confidence: 99%

“…reported on the use of either fresh whole blood or warm fresh whole blood in combination with component therapy as an intervention. The Auten et al, 24 Keneally et al, 25 and Nessen et al 26 studies performed a propensity score adjusted logistic regression analysis, whereas Spinella et al 28 . compared cohorts via a multivariable logistic regression.…”

Section: Resultsmentioning

confidence: 99%

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Whole blood transfusion versus component therapy in trauma resuscitation: a systematic review and meta‐analysis

et al. 2020

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Background Patients with hemorrhagic shock from trauma often require balanced blood product transfusion with red blood cells, plasma, and platelets. Resuscitation with whole blood resuscitation is becoming a common practice. We performed a systematic review and meta‐analysis of studies comparing whole blood transfusion with balanced component therapy in patients suffering from traumatic hemorrhagic shock. Methods We searched MEDLINE Ovid, EMBASE, and the Cochrane Library for human studies comparing whole blood with component blood therapy published from January 2007 to June 2019. We included studies from both civilian and military settings and that reported 24‐hour, in‐hospital, or 30‐day mortality. We followed the Preferred Reporting Items in Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, assessing study quality, publication bias, and heterogeneity. We used meta‐analytic models to determine the associations (odds ratio [OR] with 95% confidence interval [CI]) between whole blood transfusion and (1) 24‐hour mortality, and (2) in‐hospital or 30‐day mortality. Results A total of 1759 identified studies, 12 (reporting on n = 8431 patients) met inclusion criteria. There was heterogeneity in the design, setting, interventions, and outcomes of the studies. On meta‐analysis, whole blood transfusion was not associated with 24‐hour mortality (OR = 0.83; 95% CI = 0.56–1.24) or in‐hospital/30‐day mortality (OR = 0.79; 95% CI = 0.48–1.31). Conclusion In this systematic review and meta‐analysis, compared with conventional component transfusion, whole blood was not associated with 24‐hour or in‐hospital mortality. However, there were important limitations with and heterogeneity among the primary studies. Additional study is needed to determine the effectiveness of whole blood.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Whole blood transfusion versus component therapy in trauma resuscitation: a systematic review and meta‐analysis

et al. 2020

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“…In a multivariate analysis, Spinella et al found that fresh whole blood recipients had improved 24‐hour and 30‐day survival compared to those who received only component therapy . Auten et al and Perkins et al showed that while recipients of fresh whole blood tended to have more severe injuries than component therapy recipients, both groups had similar mortality rates at 24 hours and 30 days …”

Section: Resultsmentioning

confidence: 99%

Blood transfusion for deep space exploration

et al. 2019

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BACKGROUND Astronauts on exploration missions may be at risk for traumatic injury and medical conditions that lead to life threatening hemorrhage. Resuscitation protocols are limited by the austere conditions of spaceflight. Solutions may be found in low‐resource terrestrial settings. The existing literature on alternative blood product administration and walking blood banks was evaluated for applicability to spaceflight. STUDY DESIGN AND METHODS A literature review was done using PubMed and Google Scholar. References were crosschecked for additional publications not identified using the initial search terms. Twenty‐seven articles were identified, including three controlled trials, six retrospective cohort analyses, 15 reviews, one case report, and two experimental studies. RESULTS Solutions to blood transfusion in austere settings include lyophilized blood products, hemoglobin‐based oxygen carriers (HBOCs), and fresh whole blood. Many of these products are investigational. Protocols for walking blood banks include methods for screening and activating donors, transfusion, and monitoring for adverse reactions. Microgravity and mission limitations create additional challenges for transfusion, including baseline physiologic changes, difficulty reconstituting lyophilized products, risk of air emboli during transfusion, equipment constraints, and limited evacuation and surgical options. CONCLUSION Medical planning for space exploration should consider the possibility of acute blood loss. A model for “floating” blood banks based on terrestrial walking blood bank protocols from austere environments is presented, with suggestions for future development. Constraints on volume, mass, storage, and crew, present challenges to blood transfusion in space and must be weighed against the benefits of expanding medical capabilities.

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“…However, by the very nature of the environment, the effect may be more difficult to prove. Up to now, all data on WB in RDCR are retrospective and may well be misleading . HEH further reminded the audience of the paper by John Ioannidis (“Why most published research findings are false”), who warned that “the hotter the scientific field (with more scientific teams involved), the less likely the research findings are to be true.” HEH therefore concluded that although WB provides blood cells in a smaller volume and with lesser anticoagulant than does component therapy, the clinical advantage of WB over component therapy protocols may prove impossible to show scientifically.…”

Section: Nato Blood Panelmentioning

confidence: 99%

NATO Blood Panel perspectives on changes to military prehospital resuscitation policies: current and future practice

Woolley

Badloe

Bohoněk³

et al. 2016

Transfusion

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The North Atlantic Treaty Organization (NATO) Blood Panel exists to promote interoperability of transfusion practice between NATO partners. However, it has served as an important forum for the development of prehospital transfusion and transfusion in the austere environment. There are synergies with the trauma hemostasis and oxygen research community especially in the areas of innovation and research. Four presentations are summarized together with a review of some scientific principles. The past decade has already seen significant changes in early transfusion support. Sometimes practice has preceded the evidence and has stretched regulatory and logistic constraints. Ethical and philosophical issues are also important and require us to question “should we” and not just “could we.” The challenge for the combined communities is to continue to optimize transfusion support underpinned by evidence‐based excellence.

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The safety of early fresh, whole blood transfusion among severely battle injured at US Marine Corps forward surgical care facilities in Afghanistan

Abstract: Therapy study, level IV.

Cited by 42 publications

References 22 publications

Whole blood transfusion versus component therapy in trauma resuscitation: a systematic review and meta‐analysis

Whole blood transfusion versus component therapy in trauma resuscitation: a systematic review and meta‐analysis

Blood transfusion for deep space exploration

NATO Blood Panel perspectives on changes to military prehospital resuscitation policies: current and future practice

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