低滴度 O 型全血复苏：损伤部位的军事经验。
Low titer group O whole blood resuscitation: Military experience from the point of injury.
机构信息
From the Medical Command (A.D.F.), Texas Army National Guard, Austin, Texas; Department of Surgery (A.D.F.), UNM School of Medicine, Albuquerque, New Mexico; Prehospital Research and Innovation in Military Expeditionary Environments (A.D.F.); Maneuver Center of Excellence (E.A.M.), Fort Benning, Georgia; Joint Special Operations Command (M.A.B.), Fort Bragg, North Carolina; Army Blood Program (J.B.C.), US Army Medical Command, JBSA Fort Sam Houston, Texas; 75th Ranger Regiment (R.K.), Fort Benning, Georgia; Department of Military and Emergency Medicine (R.K.), USUHS, Bethesda, Maryland; Joint Trauma System (M.A.R., J.M.G., S.A.S.), Defense Health Agency; and United States Army Institute of Surgical Research (A.P.C.), JBSA Fort Sam Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2020 Oct;89(4):834-841. doi: 10.1097/TA.0000000000002863.
INTRODUCTION
In the far forward combat environment, the use of whole blood is recommended for the treatment of hemorrhagic shock after injury. In 2016, US military special operations teams began receiving low titer group O whole blood (LTOWB) for use at the point of injury (POI). This is a case series of the initial 15 patients who received LTOWB on the battlefield.
METHODS
Patients were identified in the Department of Defense Trauma Registry, and charts were abstracted for age, sex, nationality, mechanism of injury, injuries and physiologic criteria that triggered the transfusion, treatments at the POI, blood products received at the POI and the damage-control procedures done by the first surgical team, next level of care, initial interventions by the second surgical team, Injury Severity Score, and 30-day survival. Descriptive statistics were used to characterize the clinical data when appropriate.
RESULTS
Of the 15 casualties, the mean age was 28, 50% were US military, and 63% were gunshot wounds. Thirteen patients survived to discharge, one died of wounds after arrival at the initial resuscitative surgical care, and two died prehospital. The mean Injury Severity Score was 21.31 (SD, 18.93). Eleven (68%) of the causalities received additional blood products during evacuation/role 2 and/or role 3. Vital signs were available for 10 patients from the prehospital setting and 9 patients upon arrival at the first surgical capable facility. The mean systolic blood pressure was 80.5 prehospital and 117 mm Hg (p = 0.0002) at the first surgical facility. The mean heart rate was 105 beats per minute prehospital and 87.4 beats per minute (p = 0.075) at the first surgical facility. The mean hospital stay was 24 days.
CONCLUSION
The use of cold-stored LTOWB at POI is feasible during combat operations. Further data are needed to validate and inform best practice for POI transfusion.
LEVEL OF EVIDENCE
Therapeutic study, level V.
引言
在远战环境中，建议在受伤后使用全血治疗失血性休克。2016 年，美国特种作战部队开始在伤处（POI）使用低滴度 O 型全血（LTOWB）。这是在战场上接受 LTOWB 的最初 15 名患者的病例系列。
方法
在国防部创伤登记处确定患者，并提取图表以了解年龄、性别、国籍、损伤机制、触发输血的损伤和生理标准、POI 处的治疗、POI 处接受的血液制品以及第一手术团队进行的损伤控制程序、下一级护理、第二手术团队的初始干预、损伤严重程度评分和 30 天存活率。适当情况下使用描述性统计数据来描述临床数据。
结果
在 15 名伤员中，平均年龄为 28 岁，50%是美国军人，63%是枪伤。13 名患者存活出院，1 名在到达初始复苏性手术护理后因伤口死亡，2 名在院前死亡。平均损伤严重程度评分为 21.31（SD，18.93）。11 名（68%）伤员在撤离/角色 2 和/或角色 3 期间接受了额外的血液制品。在院前环境中可获得 10 名患者的生命体征，在第一家有能力进行手术的设施中可获得 9 名患者的生命体征。院前平均收缩压为 80.5mmHg，第一家手术设施时为 117mmHg（p=0.0002）。院前平均心率为 105 次/分钟，第一家手术设施时为 87.4 次/分钟（p=0.075）。平均住院时间为 24 天。
结论
在作战行动中，在 POI 使用冷藏的 LTOWB 是可行的。需要进一步的数据来验证和告知 POI 输血的最佳实践。
证据水平
治疗研究，V 级。
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