Page 21 - Journal of Special Operations Medicine - Summer 2016

Table 2 Laboratory Studies
Case 1 Case 2 Case 3 Case 4
Initial Transfer Initial Transfer Initial Transfer Initial Transfer
PH 7.055 7.287 7.556 7.443 7.161 7.325 7.318 7.348
Base deficit –11 0 –3 4 –11 –2 –3 –3
Hbg 10.5 11.6 15 11.2 15.3 12.9 10.2 8.2
Hct 31 34 44 33 45 38 30 24
Units of Blood Products Received
FFP 3 3 6 5

Platelets 1 1 0 1
Cryo 0 0 10 3
pRBCs 4 4 7 6
FWB 4 3 4 3
Hbg, hemoglobin; Hct, hematocrit; FFP, fresh frozen plasma; Cryo, cryoprecipitate; pRBC, packed red blood cell; FWB, fresh whole blood.

On 30-day follow-up, the patient was noted to have sur- injured patients. In this case series, the WBB was acti-
vived his injuries. No transfusion reactions or infectious vated upon receipt of the nine-line communication from
complications were noted at 30 days. unit personnel at the site of injury or via communication
with en route medevac care providers. The average time
Inflight Prehospital Activation: Case 4 to transfusion was 18.7 minutes, which is significantly
A 25-year-old male US Marine presented to the role 2 less than the previously published time to product of
MTF via the US Army medevac system after sustaining 26.7 minutes (Figure 1). In the three cases in which the
9
an injury during OEF combat operations. Communica- WBB was activated through the initial nine-line commu-
tion to the role 2 MTF was initiated by his unit corps- nication, FWB was available within 14 minutes of pa-
man and severity of injury was updated by the US Army tient arrival. All cases were CDBI with anticipated need
medevac team. The WBB was activated shortly before for massive transfusion. There were no transfusion-re-
the patient’s arrival. He arrived 31 minutes after sus- lated complications, transfer of blood-borne pathogens,
taining a left lower extremity amputation and shrapnel or death at 30 days in this limited case series.
injury to the right lower extremity. Field-applied C-A-Ts
were in place bilaterally on his upper thighs. His ISS was The JTTS CPG was established during the conflicts in
18 and initial vital signs were as follows: BP, 128/100; Iraq and Afghanistan. The CPG thoroughly discusses
HR, 145; RR, 18; and Spo , 100%. Before resuscitation, the indications for use of FWB transfusion. One of the
2
initial POC laboratory studies were significant for pH/ specific indications is the austere medical setting where
BE of 7.318/−3; his hemoglobin level was 10.2 g/dL and blood-banking capabilities may be limited or exhausted.
7
hematocrit was 30%. He received massive transfusion
with FWB as part of rDCR. The first unit of FWB was Figure 1 Injury Severity Score (ISS) and time to transfusion
transfused approximately 31 minutes after arrival (Ta- data for this four-case series.
ble 2). TXA was given during resuscitation. The patient
was intubated and a CVC was placed before salvage and
wound debridement surgery. His total OR time was 120
minutes and a response to treatment was noted (Table
1). His time of transfer from the role 2 MTF to the next
echelon of care was 160 minutes. On 30-day follow-up,
the patient was noted to have survived his injuries. No
transfusion reactions or infectious complications were
noted at 30 days.

Discussion
The concept of early activation of the WBB has the po-
tential to reduce the time to delivery of FWB to critically

Activation of Walking Blood Bank Based on Mechanism of Injury 7