Viscoelastic haemostatic assays in aeromedical transport

Bates, Alexander; Donohue, Andrew; McCullough, James P.; Winearls, James

doi:10.1111/1742-6723.13510

Cited by 7 publications

(9 citation statements)

References 30 publications

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“…However, studies in the prehospital urban population are in process, and we expect those insights to be similarly adapted in the far-forward environment as they have been in the past. While individual circumstances may still present challenges that will require further study to mitigate, we broadly envision VHA utilization in a stepwise manner in both far-forward and the austere environments similar to that initially proposed by Bates et al (Figures 2 and 3) [102].…”

Section: Time To Actionable Informationmentioning

confidence: 91%

“…Given that transport from the far-forward and austere environment can take considerable time, en route [or prehospital] care is arguably the next best setting to develop protocols for the use of VHAs. Prehospital VHAs in the far-forward combat and civilian austere environment may be useful to guide (1) initial resuscitation before transport, (2) resuscitation en route by air or ground transport, and (3) additional resuscitation on arrival to the combat support or rural hospital [102]. Expansion of VHA use in the prehospital setting as an adjunct to the administration of WB is necessarily limited by the reliability of TEG ® /ROTEM ® under commonly encountered environmental insults.…”

Section: Transportmentioning

confidence: 99%

“…It was suggested that future non-simulation testing be conducted for the cartridge VHAs [96]. Additional testing in simulated [97], non-human [99], and human [102] rotary flight environments showed that TEG ® 6 s could not be relied upon as an in-flight diagnostic tool. However, Bates et al suggested that samples could be drawn in-flight and used in the TEG ® /ROTEM ® platform immediately on touch-down at the fixed trauma facility to guide continuing resuscitation efforts [102].…”

Section: Transportmentioning

confidence: 99%

“…Additional testing in simulated [97], non-human [99], and human [102] rotary flight environments showed that TEG ® 6 s could not be relied upon as an in-flight diagnostic tool. However, Bates et al suggested that samples could be drawn in-flight and used in the TEG ® /ROTEM ® platform immediately on touch-down at the fixed trauma facility to guide continuing resuscitation efforts [102]. Yet, in-flight blood draws are impractical in many situations, indicating the need for innovative VHA technologies that use finger sticks.…”

Section: Transportmentioning

confidence: 99%

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Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

Lantry

Mason

Logsdon

et al. 2022

JCM

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Modern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy—especially in austere or challenging environments—is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival.

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Section: Time To Actionable Informationmentioning

confidence: 91%

Section: Transportmentioning

confidence: 99%

Section: Transportmentioning

confidence: 99%

Section: Transportmentioning

confidence: 99%

See 2 more Smart Citations

Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

Lantry

Mason

Logsdon

et al. 2022

JCM

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“…Indeed, initial experiments yielded promising results when the TEG6s was exposed to shaking and sudden strikes during measurements. Several experimental and one prehospital inflight study revealed conflicting results [19][20][21][22]. In order to evaluate in detail the factors that potentially influence the analytical quality of TEG6s during in-flight missions, we compared test results during helicopter operations with results that were obtained on the ground.…”

Section: Introductionmentioning

confidence: 99%

Operability of a Resonance-Based Viscoelastic Haemostatic Analyzer in the High-Vibration Environment of Air Medical Transport

Zipperle

Ziegler

Schöchl

et al. 2022

JCM

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Trauma and bleeding are associated with a high mortality, and most of these deaths occur early after injury. Viscoelastic haemostatic tests have gained increasing importance in goal-directed transfusion and bleeding management. A new generation of small-sized and thus portable ultrasound-based viscoelastic analysers have been introduced in clinical practice. We questioned whether a promising candidate can be used in emergency helicopters, with a focus on the susceptibility to vibration stress. We investigated whether the high vibration environment of an emergency helicopter would affect the operability of an ultrasound-based viscoelastic analyser and would yield reproducible results in flight and on the ground. We drew blood from 27 healthy volunteers and performed simultaneous analyses on two TEG 6s. Each measurement was performed in-flight on board an Airbus H135 emergency helicopter and was repeated on the ground, close to the flight area. Results from both measurements were compared, and the recorded tracings and numeric results were analysed for artifacts. Vibratometric measurements were performed throughout the flight in order to quantify changes in the magnitude and character of vibrations in different phases of helicopter operation. The high vibration environment was associated with the presence of artifacts in all recorded tracings. There were significant differences in citrated Kaolin + Heparinase measurements in-flight and on the ground. All other assays increased in variability but did not show significant differences between the two time points. We observed numerous artifacts in viscoelastic measurements that were performed in flight. Some parameters that were obtained from the same sample showed significant differences between in-flight and on-ground measurements. Performing resonance-based viscoelastic tests in helicopter medical service is prone to artifacts. However, a 10 min delay between initiation of measurement and take-off might produce more reliable results.

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