Page 26 - Journal of Special Operations Medicine - Winter 2015

patrols in the British Armed Forces. The use of blood Figure 8 Leukocyte-reducing, platelet-sparing filter for fresh
65
products in association with other advanced capabilities whole-blood transfusions.
on evacuation platforms has been associated with an in-
crease in survival. 66–68

Combatant-to-combatant “buddy” transfusions have
been used successfully in US Military operations, and
69
may be life saving. Type O, low A-, low B-titer whole
blood has been proposed as the universal donor for
whole-blood transfusions, 62,63,70 and some Combat units
are now actively working to implement this mode of re-
suscitation. Figure 6 depicts a Ranger medic preparing
71
for a whole-blood transfusion in a training exercise. Fig-
ure 7 shows a field blood-transfusion kit, and Figure 8 Photo courtesy of Dr Warren Dorlac
shows a leukocyte-reducing platelet-sparing filter.

Figure 6 Ranger medic preparing for a whole-blood
transfusion in a training exercise.
cells, plasma, and platelets, need to be explored and
optimized. Although component therapy has not pro-
vided outcomes as good as the results obtained with
fresh whole blood, resuscitation with balanced blood-
component therapy is clearly better than resuscitation
with either crystalloids or colloids for casualties in hem-
Photo courtesy of MAJ Ethan Miles orrhagic shock.
12

9. (Tie) Perform comparative studies of resuscitative en-
dovascular balloon occlusion of the aorta (REBOA) ver-
sus the abdominal aortic junctional tourniquet (AAJT)
versus polyurethane self-expanding foam, with an evalu-
ation of the advantages and disadvantages of each option.
Figure 7 Field blood-transfusion kit.
The increasing emphasis on DCR and recognition of the The US Military has had excellent success with the use
need to provide hemostatic capability along with red of tourniquets and hemostatic dressings to control exter-
cells and volume have caused crystalloid and colloid use nal hemorrhage, especially extremity hemorrhage, with a
to decline in popularity, even in the prehospital setting. resulting dramatic drop in preventable deaths from this
12
This necessitates the continued development of new op- cause. Multiple junctional pressure devices are also avail-
2
tions for optimizing delivery methods for whole blood able now to control junctional hemorrhage. Exsanguina-
23
and blood-component therapy in the prehospital setting. tion from noncompressible hemorrhage, however, remains
the leading cause of preventable death on the battlefield
9. (Tie) Study methods for increasing the availability, and offers the greatest challenge to medical researchers.
Photo courtesy of Dr Warren Dorlac platelets, and whole blood in the deployed combat envi- fluid resuscitation from hemorrhagic shock; avoidance of
The use of tranexamic acid (TXA); controlled volume
safety, efficacy, and shelf life of cold stored plasma,
ronment—in particular, a cryoprotective agent to allow
platelet-inhibiting nonsteroidal anti- inflammatory drug
type O, low titer, whole blood to be frozen for storage,
use in combat theaters; and prevention of hypothermia
then used later with full hemostatic function of plasma
in combat casualties are the first steps toward reducing
and platelets.
Additionally, a number of promising new technologies
There is overlap of this research requirement with the mortality in noncompressible hemorrhage.
one discussed immediately above. While transfusion to assist in controlling noncompressible hemorrhage
programs using freshly collected type O, low anti-A/ are being evaulated, including REBOA; the AAJT ;
™
anti-B–titer whole blood are an option being explored intraperitoneally injected polyurethane self-expanding
by the US Military, other options need to be explored foam (ResQFoam ); and the pelvic hemostasis belt.
™
as well. Techniques and technology to enhance the stor-
age life and usability of both cold-stored type O, low REBOA entails an endovascular balloon occlusion of the
anti-A/anti-B–titer whole blood, as well as stored red aorta. Although generally inserted in medical treatment

14 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015