Page 74 - JSOM Fall 2025

Alternative Plasma Thawers for
Austere Resuscitative Surgical Teams

Literature Review

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Brendan S. Filip, BSN ; Zacharie R. Frank, BSN ;
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Francisco J. Aguirre, DNP ; Donald J. Vallier, DNP *

ABSTRACT
Introduction: The purpose of this literature review is to iden- Blood product acquisition, management, and administration
tify optimal alternative fresh frozen plasma thawing devices are among the highest priorities for ARSC teams supporting
for Austere Resuscitative and Surgical Care (ARSC) teams op- austere missions with limited resources. Fresh frozen plasma
erating in far forward settings constrained by logistical and (FFP) is a blood product with unique storage and administra-
operational requirements. Methods: The authors reviewed ex- tion requirements. It is stored frozen at –30°C and must be
isting literature to identify optimal alternative plasma thawing thawed safely and completely before administration. FFP is
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devices and assessed power consumption, weight, durability, unlike whole blood (WB) or even liquid plasma, which is never
portability, post-thaw coagulation preservation, and thaw ki- frozen and has respective storage temperatures of 1–6°C. Ide-
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netics. Field-adapted plasma thawers and other commercially ally, ARSC teams would not use FFP given these identified
available plasma thawing systems were analyzed to determine limitations, instead opting for WB or liquid plasma whenever
their suitability to meet the needs of ARSC teams. Sixteen ar- possible for treatment of coagulation deficiencies in a hemor-
ticles were included after evaluating methodological quality rhaging patient. However, logistical constraints exist in austere
and strength of evidence. Conclusion: The authors recom- environments, and understanding how to store, thaw, and ad-
mend that ARSC teams use whole blood, liquid plasma, and minister FFP safely is vital to patient survivability.
FDA-approved thawing devices whenever available. However,
if these options are not feasible, alternative methods should be Conventional U.S. Army medical teams are frequently issued
considered to meet mission requirements. Among the devices gold-standard clinical plasma thawer devices (e.g., Helmer
reviewed, the sous vide demonstrated potential for this appli- QuickThaw ) to thaw FFP safely and in a timely manner be-
®
cation. They are lightweight, compact, versatile, and capable fore administration. The Helmer QuickThaw (Helmer Sci-
®
of creating target temperature-controlled circulating water entific Inc., Noblesville, IN) is an FDA-approved device that
baths, making them superior when compared to other iden- uses a 37°C temperature-controlled circulating water bath and
tified field-adapted devices. Dry-based thawing systems, such can thaw a flat frozen 250mL FFP unit in 10–16 minutes.
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as the ZipThaw , may also offer advantages by conserving However, despite its desirable performance ability, the Helmer
™
resources like water and electricity; however, further research QuickThaw has limited use for ARSC teams operating in envi-
is needed to validate its effectiveness in forward operating ronments with space restrictions, unreliable power, and limited
environments. water supply. As a result, ARSC teams may need to use alter-
native plasma thawing devices to adapt to these conditions.
Keywords: plasma thawer; fresh frozen plasma thawer;
microwave plasma thawer; field-adapted plasma thawer; Currently, limited studies examine the safe and efficient oper-
water bath fresh frozen plasma thawer; FFP ation of field-adapted plasma thawers. The Joint Trauma Sys-
tem (JTS) Clinical Practice Guidelines (CPG) for ARSC states
that “Portable water heaters and thermometers can be used to
create a 30–37°C bath of water to thaw FFP and warm PRBCs
Introduction
to the appropriate temperature of 37°C; however, they are not
The changing dynamics of global conflict in the previous de- FDA approved for this use.” The lack of specific operating
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cades have altered how combat operations and medicine are guidance for field-adapted plasma thawers may lead to inap-
conducted. With advances in medical technology and the in- propriate device use, resulting in cryoprecipitate formation,
creasing ability to aid wounded combatants near the point FFP bag rupture, incomplete thawing, and delayed product
of injury, a model of smaller, mobile surgical care teams has administration.
developed. These teams, colloquially known as Austere Resus-
citative and Surgical Care (ARSC) teams, contain the bare min- For ARSC teams, choosing an optimal field-adapted plasma
imum of personnel and equipment required to provide surgical thawer device can be complex and depends mainly on oper-
and resuscitative capabilities in far forward environments. ational variables (i.e., reliable electricity, transport methods,

*Correspondence to donald.j.vallier2.civ@health.mil
1 CPT Brendan S. Filip and CPT Zacharie R. Frank are Nurse Anesthesia Residents affiliated with William Beaumont Army Medical Center
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Phase 2 Nurse Anesthesia Clinical Site, El Paso, TX. MAJ Francisco J. Aguirre is a Nurse Anesthetist and is the Commander of the 37th Forward
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Resuscitative Surgical Detachment, El Paso, TX. Dr. Donald J. Vallier is a Phase 2 Assistant Clinical Site Director, U.S. Army Graduate Program
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in Anesthesia Nursing affiliated with the William Beaumont Army Medical Center, El Paso, TX.
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