Christopher Kalhagen Bjerkvig1,2,3,4, Geir Strandenes5,6, Tor Hervig5,7, Geir Arne Sunde1,4, Torunn Oveland Apelseth3,5,6. 1. Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. 2. Norwegian Naval Special Operations Commando, Norwegian Armed Forces, Bergen, Norway. 3. Institute of Clinical Science, University of Bergen, Bergen, Norway. 4. Helicopter Emergency Medical Services, HEMS-Bergen, Bergen, Norway. 5. Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway. 6. Department of War Surgery and Emergency Medicine, Norwegian Armed Forces, Medical Services, Oslo, Norway. 7. Laboratory of Immunology and Transfusion Medicine, Haugesund Hospital, Haugesund, Norway.
Abstract
BACKGROUND: Prehospital management of severe hemorrhage has evolved significantly in Norwegian medical emergency services in the last 10 years. Treatment algorithms for severe bleeding were previously focused on restoration of the blood volume by administration of crystalloids and colloids, but now the national trauma system guidelines recommend early balanced transfusion therapy according to remote damage control resuscitation principles. MATERIALS AND METHODS: This survey describes the implementation, utilization, and experience of the use of low titer group O whole blood (LTOWB) and blood components in air ambulance services in Norway. Medical directors from all air ambulance bases in Norway as well as the blood banks that support LTOWB were invited to participate. RESULTS: Medical directors from all 13 helicopter emergency medical services (HEMS) bases, the 7 search and rescue (SAR) helicopter bases, and the 4 blood banks that support HEMS with LTOWB responded to the survey. All HEMS and SAR helicopter services carry LTOWB or blood components. Four of 20 (20%) HEMS bases have implemented LTOWB. A majority of services (18/20, 90%) have a preference for LTOWB, primarily because LTOWB enables early balanced transfusion and has logistical benefits in time-critical emergencies and during prolonged evacuations. CONCLUSION: HEMS services and blood banks report favorable experiences in the implementation and utilization of LTOWB. Prehospital balanced blood transfusion using whole blood is feasible in Norway.
BACKGROUND: Prehospital management of severe hemorrhage has evolved significantly in Norwegian medical emergency services in the last 10 years. Treatment algorithms for severe bleeding were previously focused on restoration of the blood volume by administration of crystalloids and colloids, but now the national trauma system guidelines recommend early balanced transfusion therapy according to remote damage control resuscitation principles. MATERIALS AND METHODS: This survey describes the implementation, utilization, and experience of the use of low titer group O whole blood (LTOWB) and blood components in air ambulance services in Norway. Medical directors from all air ambulance bases in Norway as well as the blood banks that support LTOWB were invited to participate. RESULTS: Medical directors from all 13 helicopter emergency medical services (HEMS) bases, the 7 search and rescue (SAR) helicopter bases, and the 4 blood banks that support HEMS with LTOWB responded to the survey. All HEMS and SAR helicopter services carry LTOWB or blood components. Four of 20 (20%) HEMS bases have implemented LTOWB. A majority of services (18/20, 90%) have a preference for LTOWB, primarily because LTOWB enables early balanced transfusion and has logistical benefits in time-critical emergencies and during prolonged evacuations. CONCLUSION: HEMS services and blood banks report favorable experiences in the implementation and utilization of LTOWB. Prehospital balanced blood transfusion using whole blood is feasible in Norway.
Authors: John B Holcomb; Barbara C Tilley; Sarah Baraniuk; Erin E Fox; Charles E Wade; Jeanette M Podbielski; Deborah J del Junco; Karen J Brasel; Eileen M Bulger; Rachael A Callcut; Mitchell Jay Cohen; Bryan A Cotton; Timothy C Fabian; Kenji Inaba; Jeffrey D Kerby; Peter Muskat; Terence O'Keeffe; Sandro Rizoli; Bryce R H Robinson; Thomas M Scalea; Martin A Schreiber; Deborah M Stein; Jordan A Weinberg; Jeannie L Callum; John R Hess; Nena Matijevic; Christopher N Miller; Jean-Francois Pittet; David B Hoyt; Gail D Pearson; Brian Leroux; Gerald van Belle Journal: JAMA Date: 2015-02-03 Impact factor: 56.272
Authors: Geir A Sunde; Bjarne Vikenes; Geir Strandenes; Kjell-Christian Flo; Tor A Hervig; Einar K Kristoffersen; Jon-Kenneth Heltne Journal: J Trauma Acute Care Surg Date: 2015-06 Impact factor: 3.313
Authors: Christopher K Bjerkvig; Geir Strandenes; Håkon S Eliassen; Philip C Spinella; Theodor K Fosse; Andrew P Cap; Kevin R Ward Journal: Transfusion Date: 2016-04 Impact factor: 3.157
Authors: Christopher Bjerkvig; Joar Sivertsen; Hanne Braathen; Turid Helen Felli Lunde; Geir Strandenes; Jörg Assmus; Tor Hervig; Andrew Cap; Einar K Kristoffersen; Theodor Fosse; Torunn Oveland Apelseth Journal: Transfusion Date: 2020-04-22 Impact factor: 3.157
Authors: Mark H Yazer; Byron Jackson; Jason L Sperry; Louis Alarcon; Darrell J Triulzi; Alan D Murdock Journal: J Trauma Acute Care Surg Date: 2016-07 Impact factor: 3.313
Authors: Jason L Sperry; Francis X Guyette; Joshua B Brown; Mark H Yazer; Darrell J Triulzi; Barbara J Early-Young; Peter W Adams; Brian J Daley; Richard S Miller; Brian G Harbrecht; Jeffrey A Claridge; Herb A Phelan; William R Witham; A Tyler Putnam; Therese M Duane; Louis H Alarcon; Clifton W Callaway; Brian S Zuckerbraun; Matthew D Neal; Matthew R Rosengart; Raquel M Forsythe; Timothy R Billiar; Donald M Yealy; Andrew B Peitzman; Mazen S Zenati Journal: N Engl J Med Date: 2018-07-26 Impact factor: 91.245