Sanders Steven, Tien Homer, Callum Jeannie, Nascimento Barto, Peng Henry, Funk Chris, Schmid Joanne, Rizoli Sandro, Rhind Shawn, Beckett Andrew
McGill University, Montreal, H3Z 2G5, Canada.
Royal Canadian Medical Services, Ottawa, K1A 0K2, Canada.
Mil Med. 2018 Jan 1;183(1-2):e45-e50. doi: 10.1093/milmed/usx057.
Hemorrhage is the most common cause of death among Special Operations Force (SOF) soldiers. Bringing remote damage control resuscitation into the far-forward combat environment is logistically challenging, as it requires blood products that generally require a robust cold chain. Alternatively, lyophilized products such as fibrinogen concentrate, which does not require thawing or blood group compatibility testing before use, might be advantageous in damage control resuscitation in the battlefield. In this report, we review the evidence for the use of fibrinogen concentrate in the Canadian SOF environment.
The literature on the use of fibrinogen concentrate in the trauma setting was reviewed by Canadian Forces Services Working Group, in three separate meetings. Multiple stakeholders were consulted to obtain authoritative perspectives from subject matter experts on the use of fibrinogen concentrate in the Canadian SOF environment. We also conducted a comparison review of fibrinogen content, pathogen risk, shelf life, and methods required for use for fresh frozen plasma, cryoprecipitate, and fibrinogen concentrate relevant to their application in the far-forward combat environment.
Indications and a protocol for the use of fibrinogen as an adjunct to fresh whole blood were formulated based on a literature review and clinical expert opinion. Alternative strategies and other lyophilized blood products were considered before selecting fibrinogen concentrate as the lyophilized blood product of choice. Fibrinogen concentrate is an ABO-universal blood product with an excellent safety profile. Training was conducted by subject matter experts within civilian trauma centers and at military training facilities. The clinical efficacy and safety were confirmed by monitoring the use of fibrinogen concentrate in deployed combat settings.
Fibrinogen concentrate is a useful adjunct to remote damage control resuscitation in the SOF environment. Fibrinogen concentrate was found to be robust for transport into the SOF environment and is widely accepted among SOF operators and medics.
出血是特种作战部队（SOF）士兵最常见的死亡原因。将远程损伤控制复苏引入前沿作战环境在后勤方面具有挑战性，因为这需要血液制品，而这些制品通常需要强大的冷链。另外，冻干制品，如纤维蛋白原浓缩物，在使用前无需解冻或进行血型相容性检测，在战场损伤控制复苏中可能具有优势。在本报告中，我们回顾了在加拿大特种作战部队环境中使用纤维蛋白原浓缩物的证据。
加拿大部队服务工作组在三次单独会议上对创伤环境中使用纤维蛋白原浓缩物的文献进行了回顾。咨询了多个利益相关者，以获取主题专家对在加拿大特种作战部队环境中使用纤维蛋白原浓缩物的权威观点。我们还对新鲜冰冻血浆、冷沉淀和纤维蛋白原浓缩物的纤维蛋白原含量、病原体风险、保质期以及在前沿作战环境中的使用所需方法进行了比较性综述。
基于文献综述和临床专家意见，制定了将纤维蛋白原作为新鲜全血辅助剂使用的适应症和方案。在选择纤维蛋白原浓缩物作为首选冻干血液制品之前，考虑了替代策略和其他冻干血液制品。纤维蛋白原浓缩物是一种ABO通用血液制品，具有出色的安全性。由民用创伤中心和军事训练设施的主题专家进行了培训。通过监测纤维蛋白原浓缩物在部署作战环境中的使用情况，证实了其临床疗效和安全性。
纤维蛋白原浓缩物是特种作战部队环境中远程损伤控制复苏的有用辅助剂。发现纤维蛋白原浓缩物在运输到特种作战部队环境中时性能稳定，并且在特种作战部队操作人员和医务人员中广泛接受。
