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IV fluid warmers (Buddy Lite, enFlow, Thermal Angel) replace 9. Milligan J, Lee A, Gill M, Weatherall A, et al. Performance com-
larger traditional hospital IV fluid warmers in theater, but parison of improvised prehospital blood warming techniques and
their ability to warm blood in a massive resuscitation requires a commercial blood warmer. Injury. 2016;47(8):1824–1827.
additional analysis. With cooled fluids (5–10°C), the enFlow 10. Zoremba N, Bruells C, Rossaint R, Breuer T. Heating capabilities
of small fluid warming systems. BMC Anesthesiol. 2018;18(1):98.
consistently produced higher outlet temperatures, effectively 11. Thermal Angel. https://thermalangel.com/. Accessed 18 July 2022.
warmed greater volumes, reached time to peak temperature 12. Vital Signs, GE Healthcare. enFlow IV fluid/blood warming op-
fastest, and produced greatest flow rates, compared to the erator’s manual. July 2014. https://ia803208.us.archive.org/17/
Thermal Angel and the Buddy Lite. The Thermal Angel out- items/manual_GE_enFlow_Operating_Manual/GE_enFlow_
performed the Buddy Lite in all outcome measures; however, Operating_Manual.pdf. Accessed 18 July 2022.
the UB1 energy source limits performance. Combat conditions 13. Dubick MA, Brooks DE, Macaitis JM, et al. Evaluation of com-
predispose Servicemembers to hypothermic conditions. There- mercially available fluid-warming devices for use in forward sur-
gical and combat areas. Mil Med. 2005;170(1):76–82.
fore, it is paramount that battery-operated IV fluid warmers 14. Bridges E, Schmelz J, Evers K. Efficacy of the blizzard blanket or
can warm a range of fluids to maintain core temperatures blizzard blanket plus thermal angel in preventing hypothermia in
(>35.5°C) during DCS and DCR operations. In DCR scenar- a hemorrhagic shock victim (Sus scrofa) under operational condi-
ios, IV fluid warmers must effectively warm large volumes tions. Mil Med. 2007;172(1):17–23.
of blood products at high flow rates to create the conditions
conducive to a successful resuscitation. Based on the available
evidence, the authors conclude that each IV fluid warmer pro-
vides utility in different clinical and operational circumstances.
However, despite the enFlow’s favorable performance metrics
and versatility, the enFlow may expose patients to high levels
of aluminum. In clinical situations where the benefits outweigh
the risks, or when no alternative IV fluid warmer is available,
the authors recommend employing strategies that may reduce
aluminum elution to the patient.

Conflicts of Interest
The authors declare no financial conflict of interest with any
of the battery-operated IV fluid warmers. However, some of
the authors have personally used battery-operated IV fluid
warmers for blood transfusions in patient care.
Disclaimer
The view(s) expressed herein are those of the author(s) and
do not reflect the official policy or position of Brooke Army
Medical Center, the US Army Medical Department, the US
Army Office of the Surgeon General, the Department of the
Air Force, the Department of the Army, the Defense Health
Agency, or the Department of Defense or the US Government.

References
1. Joint Trauma System. Damage control resuscitation. https://jts.
health.mil/index.cfm/PI_CPGs/damage_control. Accessed 18 July
2022.
2. US Food and Drug Administration. Class 1 device recall enFlow
IV fluid warmer. 13 March 2019. https://www.accessdata.fda.gov
/scripts/cdrh/cfdocs/cfres/res.cfm?id=171533. Accessed 18 July
2022.
3. Perl T, Kunze-Szikszay N, Bräuer A, et al. Aluminium release by
coated uncoated fluid-warming devices. Anaesthesia. 2019;74(6):
708–713.
4. Taylor MH, Choi D, Fitzpatrick SM, Gunn KN. Characterisation
of aluminium release by the enFlow fluid-warming system in crys-
talloids and blood products. Anaesthesia. 2019;74(11):1374–1380.
5. NHS Purchasing and Supply Agency. Market review: Intravenous
fluid warming devices. March 2010. http://www.cedar.wales.nhs.
uk/sitesplus/documents/1091/CEP10014%20IV%20fluid%20
warmers%20MR.pdf. Accessed 18 July 2022.
6. Kim HJ, Yoo SM, Jung JS, et al. The laboratory performance of the
™
®
®
enFLOW , buddy lite and ThermoSens fluid warmers. Anaesthe-
sia. 2015;70(2):205–208.
7. Bruells CS, Bruells AC, Rossaint R, et al. A laboratory comparison
of the performance of the buddy lite and enFlow fluid warmers.
®
™
Anaesthesia. 2013;68(11):1161–1164.
8. Lehavi A, Yitzhak A, Jarassy R, et al. Comparison of the perfor-
mance of battery-operated fluid warmers. Emerg Med J. 2018;35
(9):564–570.
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