Noorman Femke, van Dongen Thijs T C F, Plat Marie-Christine J, Badloe John F, Hess John R, Hoencamp Rigo
Military Blood Bank, Ministry of Defense, Leiden, The Netherlands.
Ministry of Defense and Department of Trauma, Division of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
PLoS One. 2016 Dec 13;11(12):e0168401. doi: 10.1371/journal.pone.0168401. eCollection 2016.
The Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties.
Hemovigilance and combat casualties data from Afghanistan 2006-2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1-5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP.
No ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products.
This report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in remote areas.
荷兰武装部队使用储存在-80°C的冷冻红细胞、血浆和血小板，并结合常规液体储存的红细胞，用于治疗国外医疗设施中的（军事）伤员。我们的目标是评估和比较-80°C冷冻血液制品与不同输血方案的使用情况及其对创伤伤员治疗结果的影响。
回顾性分析2006年至2010年来自阿富汗的272例（军事）创伤伤员的血液监测和战斗伤亡数据，这些伤员有或没有大量输血（MT：≥6单位红细胞/24小时，N = 82；非MT：1-5单位红细胞/24小时，N = 190）。2007年11月，在军事战区引入了针对高级创伤生命支持（ATLS®）III/IV级出血的大量输血方案（MTP；红细胞：血浆：血小板比例为4:3:1）。在引入MTP之前和之后评估血液制品的使用、损伤严重程度和死亡率。将数据与 civilian 和军事创伤研究进行比较，以评估冷冻血液制品和MTP的有效性。
未输注ABO血型不匹配的血液制品，在3060次输注的制品中仅观察到1例轻度输血反应。MTP实施后，MT患者的院内死亡率从44%降至14%（P = 0.005），非MT患者的院内死亡率从12.7%降至5.9%（P = 0.139）。平均24小时红细胞、血浆和血小板比例具有可比性，与使用类似数量的液体储存（和现场捐献）血液制品的研究相比，伴随的24小时死亡率较低。
本报告首次描述了-80°C冷冻血小板、血浆和红细胞的组合在治疗（军事）创伤伤员方面是安全的，并且至少与标准血液制品一样有效。冷冻血液可以挽救武装冲突伤员的生命，而无需在战区采血。这些结果也可能有助于解决偏远地区民用血液供应中的后勤问题。
