Page 15 - JSOM Winter 2024

Rethinking the Operational Blood Bank Dilemma

Out of the “Box” Blood Storage and Transportation Evaluation

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Scott Hughey, MD *; Joshua Kotler, MD ; Adam Brust, MD ; Jacob Cole, MD ;
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Yuki Itani, MD ; Anna Hughey, MA ; Takashi Nagata, MD ; Kyle Checchi, MD 8
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ABSTRACT
Background: Blood transfusion is critical in modern trauma the Joint Trauma System (JTS). LTOWB is a lifesaving treat-
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care. However, unreliable access to robust blood banking in ment for patients with traumatic hemorrhage. However, the
austere military and disaster medicine settings remains chal- benefits of LTOWB donation are limited by the constraints
lenging. Stored whole blood and components have strict refrig- of storage (i.e., blood is only good for 35 days following do-
eration guidelines; any cold-chain storage liability that results nation). In addition, blood must be stored at constant tem-
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in blood products deviating from their target temperatures perature of 1–6°C to be considered safe for use by the United
affects patient safety. Refrigeration in a typical blood bank States Food and Drug Administration (FDA). In a deployed
requires large, specialized devices. Transportable, battery- or austere setting, blood bank resources are limited, and re-
operated devices are available, but they have limited battery frigeration options may be unreliable or unsuitable to mission
life. This study evaluated the possibility of using passively requirements.
cooled devices (commercially available food coolers) to store
blood components. Methods: A commercially available 45-liter Emergency fresh whole blood (EFWB) programs like Ranger
capacity cooler was used. Saline bags (500mL) were precooled O Low Titer (ROLO) may help expedite access to rapid blood
to 1–6°C and placed in the cooler. A thermometer placed in the product resuscitation, despite limited refrigeration options in
cooler adjacent to each saline bag measured the cooler tem- austere military environments, through fresh whole blood
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perature throughout each trial. The primary outcome was the from bystanders. In civilian medicine, LTOWB carried by
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hours of adequate refrigeration (between 1 and 6°C). Results: air and ground ambulances appears to improve outcomes
There were four trials, each lasting 168 hours. Trials 1–3 main- in trauma. 9–12 Emerging evidence increasingly supports early
tained the goal temperature range for >142 hours, while trial 4 LTOWB use as close to the time of injury as possible, with an
maintained temperature range for 78 hours. Conclusion: Pas- estimated 2% increased risk of mortality with every minute
sive refrigeration using commercially available coolers and ice delay in transfusion administration. 13
is a viable alternative to traditional blood storage solutions in
austere, disaster, and military operational environments. Fur- Balancing the need for LTOWB in trauma with the limitations
ther studies should investigate prolonged blood storage using of refrigeration and blood banking in austere settings creates
this technique with the periodic addition of ice. a challenge for trauma care providers and logisticians alike.
Reimagining traditional refrigeration with commercially avail-
Keywords: blood transfusion; operational medicine; unmanned able blood storage systems has been explored. 14–16 If passive
aerial systems; transfusion; passive refrigeration refrigeration (thermally isolated coolers) can keep blood prod-
ucts cooled between 1–6°C in the warm summer climate of
the subtropical region of the Indo-Pacific Command Area of
Responsibility (INDOPACOM AOR), it may change the dy-
Introduction
namic of traditional blood banking in favor of far forward
Blood transfusion is critical for the resuscitation of severely LTOWB availability. Such forward LTOWB availability may
injured combat trauma patients. The increased availability of substantially impact trauma care quality in the austere settings
blood products for resuscitation in recent conflicts has been of competition and complex disasters. This study sought to
associated with decreased mortality, and low titer group O evaluate the reliability of passive refrigeration for blood stor-
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whole blood (LTOWB) transfusion is now recommended by age within INDOPACOM AOR in a real-world environment.
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*Correspondence to Scott Hughey, Department of Anesthesiology and Pain Medicine, Naval Hospital Okinawa, PSC 482 Box 1600 FPO AP
96362 or scott.b.hughey.mil@health.mil
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1 LCDR Scott Hughey, Dr. Yuki Itani, and Anna Hughey are affiliated with the Department of Anesthesiology and Pain Medicine, Naval Hos-
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pital Okinawa, Okinawa, Japan. LCDR Scott Hughey, LCDR Joshua Kotler, CDR Adam Brust, LCDR Jacob Cole, and LCDR Kyle Checchi
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are affiliated with the Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA. LCDR Joshua Kotler is affiliated with
the III Marine Expeditionary Force, Okinawa, Japan. CDR Adam Brust is affiliated with the Department of Anesthesiology and Pain Medicine,
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Naval Hospital Pensacola, Pensacola, FL. LCDR Jacob Cole is affiliated with the Uniformed Services University, Bethesda, MD. COL Takashi
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Nagata is affiliated with the Japanese Ground Self Defense Force Sapporo Hospital, Sapporo, Japan. LCDR Kyle Checchi is affiliated with the
Department of Surgery, Naval Hospital Okinawa, Okinawa, Japan.
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