Page 140 - JSOM Fall 2022

A Sampling of TCCC and
ERCCC Journal Watch Abstracts From 2021

Harold R. Montgomery, ATP; Thomas A. Rich, NREMT-P;
Brendon G. Drew, DO; Cord Cunningham, MD; Frank K. Butler, MD

he Committee on Tactical Combat Casualty Care (CoTCCC) A Prehospital Scoring System for Predicting the
and the Committee on En Route Combat Casualty Care Need for Emergent Blood Product Transfusion
T(CoERCCC) conduct a monthly screening and review of Guy Avital, Shaul Gelikas, Irina Radomislensky, Avishai M. Tsur,
the published medical literature for relevance to the tactical, pre­ Alex Sorkin, Eilat Shinar, Moran Bodas, Mark H. Yazer,
hospital, and en route care guidelines and operational commu­ Andrew P. Cap, Jacob Chen, Elon Glassberg, Avi Benov
nities. Since 2008, the CoTCCC has published and distributed a Transfusion. 2021;61 Suppl 1:S195–S205.
quarterly journal watch and CoERCCC was added in 2020. We
now publish a combined quarterly and annual journal watch on Background: Several tools have been proven to predict the need
Deployed Medicine. This journal watch can be accessed at www for massive transfusion in trauma casualties, yet tools that are
.deployedmedicine.com or by downloading the Deployed Medi­ easily applicable in the prehospital setting for predicting the need
cine mobile application to a phone or device. for any blood product transfusion in the emergency department
(ED) are lacking. Methods: A retrospective analysis of the cross­
The journal watch effort is a critical component to the TCCC and referenced Israeli Defense Forces Trauma Registry and the Israeli
ERCCC clinical practice guidelines remaining evidence­based and National Trauma Registry databases was performed to identify
up to date with current medical practice and application. Since predictors for any blood product transfusion in the ED. A scor­
their inception, the committees have updated their guidelines ing system was developed after internally validating the predic­
based on ongoing review of the published civilian and military tion model. Division to risk groups was performed. Results: Seven
prehospital trauma literature contrasted with interaction with mil­ variables (systolic blood pressure, heart rate, arterial oxygen sat­
itary combat casualty care research institutions; Joint Trauma Sys­ uration, trunk involvement, mechanism of injury, chest decom­
tem case reports; input from service lessons learned centers; and pression, and tourniquet application) were included in the scoring
direct input from experienced combat medical personnel. system, ranging from 0 to 11.5. Risk groups for ED transfusion
Using a keyword search of 83 combination terms and the PubMed. included very low (0.8%), low (3.2%), intermediate (8.5%), and
gov search site, Danielle Davis conducts a monthly pull of medical high (31.2%) risk. Conclusion: A scoring system for predicting
literature abstracts. These abstracts are then reviewed and identi­ the need for any blood product transfusion in the ED was devel­
fied by the CoTCCC and CoERCCC staff for relevance to ongoing oped, based on information readily available in the early stages of
and potential committee efforts. The identified abstracts are then prehospital resuscitation, allowing the receiving medical facility to
pulled as full articles for a more thorough review for applicability. prepare for that need.
Articles pertinent to ongoing change proposals are provided to the
change leads for potential inclusion their work efforts. Those and The Impact of Prehospital TXA on Mortality Among
remaining articles specifically related to TCCC and ERCCC topics Bleeding Trauma Patients: A Systematic Review and
are included in the combined quarterly journal watch. Meta-Analysis
Ateeq Almuwallad, Elaine Cole, Jennifer Ross, Zane Perkins,
The review and selection of articles for inclusion in the journal Ross Davenport
watch does not imply agreement or disagreement with the contents J Trauma Acute Care Surg. 2021;90(5):901–907.
nor constitute a change in TCCC or ERCCC guidelines, practices,
or training. Additionally, neither selection of individual articles or Background: Tranexamic acid (TXA) is an antifibrinolytic drug
publications should be construed as an endorsement by the US Gov­ associated with improved survival among trauma patients with
ernment, Department of Defense, or the Defense Health Agency. hemorrhage. Tranexamic acid is considered a primary hemostatic
intervention in prehospital for treatment of bleeding alongside
On the Deployed Medicine site, links are provided to respective blood product transfusion. Methods: A systematic review and
publications for further reading and research. Additional log­in re­ meta­analysis was conducted to investigate the impact of prehos­
quirements may be required at various medical literature or orga­ pital TXA on mortality among trauma patients with bleeding.
nizational sites. The Joint Trauma System and Deployed Medicine A systematic search was conducted using the National Institute
do not provide downloadable articles or free access to journal sites. for Health and Care Excellence Healthcare Databases Advanced
Access may be acquired through service medical departments/com­ Search library which contain the following of databases: EMBASE,
mands or medical agencies/organizations or personal subscriptions. Medline, PubMed, BNI, EMCARE, and HMIC. Other databases
In 2021, the CoTCCC and CoERCCC staff screened and reviewed searched included SCOPUS and the Cochrane Central Register
2,739 medical literature abstracts using the process described for Clinical Trials Library. Quality assessment tools were applied
above. Ultimately, 357 articles were selected for detailed review among included studies; Cochrane Risk of Bias for randomized
and inclusion in the journal watch. The abstracts that follow are a control trials and Newcastle­Ottawa Scale for cohort observa­
sampling of 25 articles published between December 2020 and De­ tional studies. Results: A total of 797 publications were identified
cember 2021. The complete list is available on Deployed Medicine. from the initial database search. After removing duplicates and

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