Dan Levin1, Maoz Zur2, Eilat Shinar3,4, Tzadok Moshe3,4, Avishai M Tsur1,5, Roy Nadler1,6, Mark H Yazer7,8, Danny Epstein1,9, Guy Avital1,10, Shaul Gelikas1, Elon Glassberg1,11,12, Avi Benov1,11, Jacob Chen1,13. 1. Trauma and Combat Medicine Branch, Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel. 2. Military Medical Academy, Medical Corps, Israel Defense Forces, Shefayim, Israel. 3. Magen David National Blood Services, Ramat Gan, Israel. 4. Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Scheva, Israel. 5. Department of Medicine B, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel. 6. Department of General Surgery and Transplantation - Surgery B, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Ramat Gan, Israel. 7. Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 8. Department of Pathology, Tel Aviv University, Tel Aviv, Israel. 9. Critical Care Division, Rambam Health Care Campus, Haifa, Israel. 10. Division of Anesthesia, Intensive Care and Pain Management, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel. 11. The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. 12. The Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA. 13. Meir Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel.
Abstract
INTRODUCTION: The Israeli Defense Forces Medical Corps (IDF-MC) implemented the use of low-titer group O whole blood (LTOWB) as the first-choice resuscitation fluid in the IDF airborne Combat Search and Rescue Unit (IDF-CSAR) for aerial evacuation of both military and civilian casualties in June 2018 for injured patients with hemorrhagic shock and at least one of the following: systolic blood pressure <90 mm Hg, heart rate >130 beats/min, deterioration of consciousness without head injury or hemoglobin concentration ≤7 g/dL. METHOD: All casualties treated with LTOWB by IDF-CSAR providers from June 2018 to January 2021 were included. Demographic and prehospital treatment data were collected in order to check compliance and adherence to the IDF-MC guidelines. This is a follow-up retrospective report. RESULTS: Overall, 1,608 LTOWB units were supplied to the IDF-CSAR during the study period. Of these, 33 were transfused to 27 casualties; 17 (69%) with blunt injury, 8 (29.6%) with penetrating injuries, and 1 (3.7%) with gastrointestinal bleeding without trauma. The leading cause of injury was motor vehicle accidents. A total of 23 casualties received 1 unit of LTOWB, 3 received 2 units and 1 patient received 4 units. Two casualties were children. The median heart rate was 120 beats/min, 8 (29.6%) casualties had heart rates >130 beats/min. Median systolic blood pressure was 95 mm Hg, 7 (26%) casualties had blood pressure <90 mm Hg. The median Glasgow Coma Score was 14. No adverse reactions were documented following the administration of LTOWB. 77.8% of patients received LTOWB in adherence to the guidelines. CONCLUSION: Appropriate administration of LTOWB has improved over time in IDF-CSAR. Using LTOWB is feasible and simpler than administering packed red blood cells and plasma concurrently. Further efforts are needed to introduce LTOWB in other prehospital and in-hospital scenarios, with an increase in the maximum antibody titer threshold, to meet the expected increase in demand.
INTRODUCTION: The Israeli Defense Forces Medical Corps (IDF-MC) implemented the use of low-titer group O whole blood (LTOWB) as the first-choice resuscitation fluid in the IDF airborne Combat Search and Rescue Unit (IDF-CSAR) for aerial evacuation of both military and civilian casualties in June 2018 for injured patients with hemorrhagic shock and at least one of the following: systolic blood pressure <90 mm Hg, heart rate >130 beats/min, deterioration of consciousness without head injury or hemoglobin concentration ≤7 g/dL. METHOD: All casualties treated with LTOWB by IDF-CSAR providers from June 2018 to January 2021 were included. Demographic and prehospital treatment data were collected in order to check compliance and adherence to the IDF-MC guidelines. This is a follow-up retrospective report. RESULTS: Overall, 1,608 LTOWB units were supplied to the IDF-CSAR during the study period. Of these, 33 were transfused to 27 casualties; 17 (69%) with blunt injury, 8 (29.6%) with penetrating injuries, and 1 (3.7%) with gastrointestinal bleeding without trauma. The leading cause of injury was motor vehicle accidents. A total of 23 casualties received 1 unit of LTOWB, 3 received 2 units and 1 patient received 4 units. Two casualties were children. The median heart rate was 120 beats/min, 8 (29.6%) casualties had heart rates >130 beats/min. Median systolic blood pressure was 95 mm Hg, 7 (26%) casualties had blood pressure <90 mm Hg. The median Glasgow Coma Score was 14. No adverse reactions were documented following the administration of LTOWB. 77.8% of patients received LTOWB in adherence to the guidelines. CONCLUSION: Appropriate administration of LTOWB has improved over time in IDF-CSAR. Using LTOWB is feasible and simpler than administering packed red blood cells and plasma concurrently. Further efforts are needed to introduce LTOWB in other prehospital and in-hospital scenarios, with an increase in the maximum antibody titer threshold, to meet the expected increase in demand.
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