Page 28 - JSOM Spring 2020

FIGURE 5 Volunteer whole blood. FIGURE 6 LTOWB with CPDA-1.

O whole blood (CS-LTOWB) from CONUS locations for use discharge, 1 died of wounds after arrival at the initial resus-
on the battlefield. The blood units were drawn at military do- citative surgical care, and 2 died prehospital (killed in action;
nor centers in the United States, screened for TTDs and titer nonsurvivable). Half of the casualties had injury severity scores
tested. Once confirmed TTD free and low titer, the units were >16, indicating severe injuries. Eleven (68%) of the causalities
shipped to the forward task force and distributed to medics received additional blood products during evacuation to Role
for transfusion to patients in hemorrhagic shock. The triggers 2 and/or Role 3 military treatment facilities. Two of five casu-
for transfusion that were developed included >1 amputation, alties who did not receive blood products upon arrival at the
blunt/penetrating torso or junctional injury, pelvic fracture, surgical teams were KIA. To date, one casualty has received
systolic blood pressure <100mmHg, heart rate >100 beats both CS-LTOWB at the POI along with fresh LTOWB under
per minute, lactate >5 mmol/L. Shortly after the decision was the ROLO program, resulting in survival of the casualty.
made, special operations units began receiving CS-LTOWB for
use at the POI with the first unit being transfused within weeks The lessons learned from prior wars continue to be relevant
of the first shipment. 15 as we adapt them to today’s conflicts. We must seek evolving
technological material solutions as well as techniques from the
Initially, the program used an IgM anti-A and -B titer of past and future to save lives. As the TCCC community, we
<1:150 by saline method for CS-LTOWB (Figure 6). The ini- must not forget to continue to master the basics and eliminate
tial shipments were in citrate-phosphate-dextrose (CPD) with preventable death while we push on toward saving the poten-
a 21-day shelf-life when stored between 1°C and 6°C. The tially survivable.
ASBP switched to citrate-phosphate-dextrose adenine solu-
tion (CPDA-1), which offered a 35-day shelf-life and changed Disclaimer
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the titer to <1:256 (Figure 6). This proved to be a signif- Opinions or assertions contained herein are the private views
icant change given the lengthy supply chain of cold stored of the authors and are not to be construed as official or as re-
blood, often doubling the length of viable blood available in flecting the views of the Texas A&M College of Medicine, the
theatre. Since the shipments of CS-LTOWB started arriving Department of the Army, the Defense Health Agency, or the
in March 2016, the CS-LTOWB transfusions have increased Department of Defense.
700% (0.5% to 4% of all transfusions in 2017). This use
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will continue to increase as CS-LTOWB becomes increasingly Disclosures
available. The authors declare no conflicts of interest.
From 2016 to 2019, there were 16 patient records in the References
Department of Defense Trauma Registry who had received 1. Cannon WB, Fraser J, Cowell EM. The preventive treatment of
CS-LTOWB at the POI. Of these patients, 13 survived to wound shock. JAMA. 1918;70(9).

24 | JSOM Volume 20, Edition 1 / Spring 2020