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The use of whole blood in US military operations in Iraq, Syria, and Afghanistan since the introduction of low‐titer Type O whole blood: feasibility, acceptability, challenges
Author(s) -
Vanderspurt Cecily K.,
Spinella Philip C.,
Cap Andrew P.,
Hill Ronnie,
Matthews Sarah A.,
Corley Jason B.,
Gurney Jennifer M.
Publication year - 2019
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.15086
Subject(s) - medicine , blood product , blood transfusion , whole blood , emergency medicine , resuscitation , blood component , intensive care medicine , medical emergency , surgery
BACKGROUND Hemorrhage is the leading cause of preventable death in military and civilian traumatic injury. Blood product resuscitation improves survival. Low‐titer Type O Whole Blood (LTOWB) was recently re‐introduced to the combat theater as a universal resuscitation product for hemorrhagic shock. This study assessed the utilization patterns of LTOWB compared to warm fresh whole blood (WFWB) and blood component therapy (CT) in US Military Operations in Iraq/Syria and Afghanistan known as Operation Inherent Resolve (OIR) and Operation Freedom's Sentinel (OFS) respectively. We hypothesized LTOWB utilization would increase over time given its advantages. STUDY DESIGN AND METHODS Using the Theater Medical Data Store, patients receiving blood products between January 2016 and December 2017 were identified. Product utilization ratios (PUR) for LTOWB, WFWB, and CT were compared across Area of Operations (AORs), medical treatment facilities (Role 2 vs. Role 3), and time. PUR was defined as number of blood products transfused/(number of blood products transfused + number of blood products wasted). RESULTS The overall PUR for all blood products was 17.4%; the LTOWB PUR was 14.3%. Over the study period, the total number of blood products transfused increased 133%. Although the total whole blood (WB) increased from 2.1% to 6.6% of all products transfused, WFWB use remained at 2% while LTOWB transfusions increased from 0.5% to 4%. Transfusion of LTOWB occurred more in austere Role 2 facilities compared to Role 3 hospitals. CONCLUSIONS LTOWB transfusion is feasible in austere, far‐forward environments. Further investigation is needed regarding the safety, clinical outcomes, and drivers of LTOWB transfusions.