Page 78 - JSOM Fall 2025

Thawing FFP using the slow cooker creates a non-controlled theaters with limited logistic capabilities. Another optimal al-
target temperature heated water bath at a small energy cost. ternative to FFP is liquid plasma because it does not require
At low temperature settings, cryoprecipitate can form, and at thawing methods and has a shelf life comparable to WB.
high temperature settings, FFP thaw times can approach over
an hour without pre-warming the water. Although the slow Limitations
cooker has a large enough basin to accommodate multiple FFP The authors of this literature review recognize the limited
units for simultaneous thawing, its fragility complicates trans- reach of this topic. Thawing FFP in an austere environment
portation and limits its use in highly mobile environments. with alternative plasma thawers may only have importance to
a niche group of medical providers. These medical providers
The electric tea kettle is durable and easy to transport, but are primarily military affiliated and function in pre-hospital
improper methods for creating an appropriately heated water settings within austere environments. Such a specific and lim-
bath can lead to burns and heat injuries if mishandled. Com- ited cohort may explain the lack of interest, research, and cur-
bining FFP incorrectly with boiled water can cause plastic bag rent educational materials on this topic.
rupture and product destruction. Multiple electric tea kettles
are often required to create heated water baths sufficient to Limited research explores the efficacy and safety of non-FDA
thaw multiple FFPs simultaneously, but this comes at a signif- field-adapted plasma thawers. Only one quasi-experimental
icant energy cost. study evaluates FFP thaw kinetics and post-thaw coagulation
preservation with identified field-adapted devices (e.g., slow
The sous vide is the only field-adapted plasma thawer device cooker, electric tea kettle, sous vide, and MRE heater). Further
with a controlled target temperature circulating water bath. Its research is needed to determine the performance characteris-
compact size and light weight make it easy to pack and deploy. tics of each device when thawing more than two units of FFP
From a durability standpoint, the Anova Precision Cooker simultaneously, which more accurately reflects the demands of
®
Pro (Anova Culinary Inc., San Francisco, CA) is constructed damage control resuscitation.
from metal and stainless steel, which may offer advantages in
durability over other devices in far forward settings. Another limitation identified was the variation in thawing
methods across studies. Average thaw time differences be-
The sous vide is highly versatile and compatible with various tween manufacturer and researcher thaw times were likely re-
basin sizes and water volumes, depending on resource consid- lated to the FFP geometrical configuration (folded versus flat).
erations. Energy cost is highest while initially warming wa- A folded frozen unit of FFP will take longer to thaw than a flat
ter to the target temperature but is then reduced significantly frozen unit. For example, in one study, researchers used over-
once the target temperature is reached. Lastly, the sous vide sized bags to completely flatten out the plasma, achieving a
has proven effective in warming cold IV fluids to normother- 3-minute FFP thaw time. These differences skewed expected
25
mic temperatures and rewarming cold WB to 34°C, which may thaw times across many devices and should be an additional
offer further advantages during resuscitation efforts. variable to consider when interpreting device performance.
MRE heaters are inexpensive and can be found in nearly every Conclusion
MRE package. They only require water for operating and have
no power requirements. However, they do not demonstrate an The authors recommend that ARSC teams utilize whole blood,
effective thawing kinetic profile and should not be used for liquid plasma, and FDA-approved thawing devices whenever
thawing FFP. available. However, if these options are not feasible, alternative
methods should be considered to meet mission requirements.
Alternative FDA-approved commercially available plasma Among the devices reviewed, the sous vide demonstrated po-
thawer systems, such as dry-based thawing devices and radio tential for this application. They are lightweight, compact, ver-
wave thawers, were also evaluated for feasibility with ARSC satile, and capable of creating target temperature-controlled
teams. Radio wave thawers were found to be incompatible with circulating water baths, making them superior when compared
far forward missions due to extensive power requirements and to other identified field-adapted devices. Dry-based thawing
physical dimensions. However, among the dry-based thawing systems, such as the ZipThaw, may also offer advantages by
systems, the ZipThaw device is shaped like a briefcase with a conserving resources like water and electricity; however, fur-
handle for transport and can thaw two units of FFP simulta- ther research is needed to validate its effectiveness in forward
neously in approximately 16 minutes. The device does not operating environments.
12
require external water but does require additional accessories
(ZipSleeves) and has been reported to have potential battery Author Contributions
compatibility in the future. DV conceived this study and obtained IRB exemption. DV, BF,
ZF, and FA wrote the first draft of this paper. All authors read
Taking into consideration the unique limitations associated and approved the final manuscript.
with thawing FFP, alternative hemostatic blood products
should be considered when available. WB is the standard for Disclaimer
hemorrhage control because it contains oxygen-carrying ca- The views expressed in this publication are those of the au-
pacity and a full complement of coagulation factors, includ- thor(s) and do not reflect the official policy or position of
ing platelets. Therefore, WB negates the need for a balanced, William Beaumont Army Medical Center, Department of the
component resuscitation and should be used when available. Army, Defense Health Agency, or the U.S. Government.
WB does not need to be frozen and can be stored safely at
1–6°C for up to 35 days. Though WB is preferential, it may The Public Affairs Office, Readiness Division, and the Depart-
2
not always be available to ARSC teams operating in immature ment of Clinical Investigation approved this publication for
76 | JSOM Volume 25, Edition 3 / Fall 2025