John B Holcomb1, Philip C Spinella2, Torunn Oveland Apelseth3,4, Frank K Butler5, Jeremy W Cannon6, Andrew P Cap5,7,8, Jason B Corley9, Heidi Doughty10, Michael Fitzpatrick11, Sara F Goldkind12, Jennifer M Gurney7, Mary J Homer13, Sarah J Ilstrup14, Jan O Jansen15, Donald H Jenkins16, Marisa B Marques17, Eugene E Moore18, Paul M Ness19, Kevin C O'Connor20, Martin A Schreiber21, Eilat Shinar22, Steve Sloan23, Geir Strandenes3,24, James R Stubbs25, Audra L Taylor26, Kevin R Ward20, Elizabeth Waltman27,28, Mark Yazer29,30,31. 1. Center for Injury Science, Division of Acute Care Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. 2. Division of Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA. 3. Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway. 4. Norwegian Armed Forces Medical Service, Sessvollmoen, Norway. 5. Uniformed Services University, Bethesda, Maryland, USA. 6. Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 7. US Army Institute of Surgical Research, San Antonio, Texas, USA. 8. Ft Sam Houston, San Antonio, Texas, USA. 9. Army Blood Program, US Army Medical Command, JBSA - Fort Sam Houston, San Antonio, Texas, USA. 10. Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK. 11. Cellphire Inc., Rockville, Maryland, USA. 12. Goldkind Consulting, L.L.C., Chevy Chase, Maryland, USA. 13. Division of Chemical, Biological, Radiological, and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, District of Columbia, USA. 14. Department of Laboratory Medicine and Pathology, Intermountain Medical Center, Salt Lake City, Utah, USA. 15. Division of Acute Care Surgery; and Director, Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA. 16. Division of Trauma and Emergency Surgery, UT Health, San Antonio, Texas, USA. 17. Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA. 18. Shock Trauma Center at Denver Health, Department of Surgery, University of Colorado Denver, Denver, Colorado, USA. 19. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 20. George Washington University School of Medicine and Health Sciences, Medical Faculty Associates, Washington, District of Columbia, USA. 21. Oregon Health & Science University, Portland, Oregon, USA. 22. Ben Gurion University, Beersheba, Israel. 23. Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 24. Department of War Surgery and Emergency Medicine, Norwegian Armed Forces Medical Services, Oslo, Norway. 25. Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA. 26. Armed Services Blood Program, Defense Health Agency, Falls Church, Virginia, USA. 27. BioBridge Global, Inc., San Antonio, Texas, USA. 28. South Texas Blood & Tissue Center, San Antonio, Texas, USA. 29. University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 30. Tel Aviv University, Tel Aviv, Israel. 31. University of Southern Denmark, Odense, Denmark.
Abstract
BACKGROUND: The current global pandemic has created unprecedented challenges in the blood supply network. Given the recent shortages, there must be a civilian plan for massively bleeding patients when there are no blood products on the shelf. Recognizing that the time to death in bleeding patients is less than 2 h, timely resupply from unaffected locations is not possible. One solution is to transfuse emergency untested whole blood (EUWB), similar to the extensive military experience fine-tuned over the last 19 years. While this concept is anathema in current civilian transfusion practice, it seems prudent to have a vetted plan in place. METHODS AND MATERIALS: During the early stages of the 2020 global pandemic, a multidisciplinary and international group of clinicians with broad experience in transfusion medicine communicated routinely. The result is a planning document that provides both background information and a high-level guide on how to emergently deliver EUWB for patients who would otherwise die of hemorrhage. RESULTS AND CONCLUSIONS: Similar plans have been utilized in remote locations, both on the battlefield and in civilian practice. The proposed recommendations are designed to provide high-level guidance for experienced blood bankers, transfusion experts, clinicians, and health authorities. Like with all emergency preparedness, it is always better to have a well-thought-out and trained plan in place, rather than trying to develop a hasty plan in the midst of a disaster. We need to prevent the potential for empty shelves and bleeding patients dying for lack of blood.
BACKGROUND: The current global pandemic has created unprecedented challenges in the blood supply network. Given the recent shortages, there must be a civilian plan for massively bleeding patients when there are no blood products on the shelf. Recognizing that the time to death in bleeding patients is less than 2 h, timely resupply from unaffected locations is not possible. One solution is to transfuse emergency untested whole blood (EUWB), similar to the extensive military experience fine-tuned over the last 19 years. While this concept is anathema in current civilian transfusion practice, it seems prudent to have a vetted plan in place. METHODS AND MATERIALS: During the early stages of the 2020 global pandemic, a multidisciplinary and international group of clinicians with broad experience in transfusion medicine communicated routinely. The result is a planning document that provides both background information and a high-level guide on how to emergently deliver EUWB for patients who would otherwise die of hemorrhage. RESULTS AND CONCLUSIONS: Similar plans have been utilized in remote locations, both on the battlefield and in civilian practice. The proposed recommendations are designed to provide high-level guidance for experienced blood bankers, transfusion experts, clinicians, and health authorities. Like with all emergency preparedness, it is always better to have a well-thought-out and trained plan in place, rather than trying to develop a hasty plan in the midst of a disaster. We need to prevent the potential for empty shelves and bleeding patients dying for lack of blood.
Authors: Noelle N Saillant; Lucy Z Kornblith; Hunter Moore; Christopher Barrett; Martin A Schreiber; Bryan A Cotton; Matthew D Neal; Robert Makar; Andrew P Cap Journal: Ann Surg Date: 2022-04-01 Impact factor: 13.787