Vallier DJ, Anderson WJ, Snelson JV, Yauger YJ, Felix JR, Alford KI, Bermoy WA. 22(4). 9 - 13. (Journal Article)
Abstract
US Army Forward Surgical Elements (FSEs) are highly mobile teams that provide damage control surgery (DCS) and damage control resuscitation (DCR) in austere locations that often lack standard hospital utilities (electricity, heat, food, and water). FSEs rely on portable battery-operated intravenous (IV) fluid warmers to remain light and mobile. However, their ability to warm blood in a massive resuscitation requires additional analysis. The purpose of this literature review is to examine the three most common battery-operated IV fluid warmers as determined by type and quantity listed on the Mission Table of Organization and Equipment (MTOE) of organic mobile medical units. These include the Buddy Lite, enFlow, and Thermal Angel, which are available to deployed US Army FSEs for blood resuscitation therapy. Based on limited available evidence, the enFlow produced higher outlet temperatures, effectively warmed greater volumes, reached the time to peak temperature faster, and produced greatest flow rates, with cool saline (5-10°C), compared to the Thermal Angel and Buddy Lite. However, recently the US Food and Drug Administration (FDA) issued a Class 1 recall on enFlow cartridges. Testing demonstrated aluminum elution from enFlow cartridges into IV solutions, thereby exposing patients to potentially unsafe aluminum levels. The authors recommend FSE units conduct a 100% enFlow cartridge inventory and seek an alternative IV fluid warming system prior to enFlow cartridge disposal. If an alternative does not exist, or the alternative warming system does not fit mission requirements, then medical personnel must carefully weigh the risks and benefits associated with the enFlow delivery system.
Keywords: Thermal Angel; enFlow; Buddy Lite; fluid warmer; intravenous fluids, IVF; cartridge
Stuart SM, Bohan ML, Mclean JB, Walchak AC, Friedrich EE. 22(4). 87 - 92. (Journal Article)
Abstract
Background: Exsanguination is the leading cause of preventable posttraumatic death, especially in the prehospital arena. Traditional hemorrhage control methods involve packing the wound with hemostatic agents, providing manual pressure, and then applying a pressure dressing to stabilize the treatment. This is a lengthy process that frequently destabilizes upon patient transport. Conversely, the iTClamp, a compact wound closure device, is designed to rapidly seal wound edges mechanically, expediting clot formation at the site of injury. Objectives: To determine the efficacy of the iTClamp with and without wound packing in the control of a lethal junction hemorrhage. Methods: Given the limited available information regarding the efficacy of the iTClamp in conjunction with traditional hemostatic agents, this study used a swine model of severe junctional hemorrhage. The goal was to compare a multiagent strategy using the iTClamp in conjunction with XSTAT to the traditional method of Combat Gauze packing with pressure dressing application. Readouts include application time, blood loss, and rebleed occurrence. Results: Mean application times of the iTClamp treatment alone or in conjunction with other hemostatic agents were at least 75% faster than the application time of Combat Gauze with pressure dressing. Percent blood loss was not significantly different between groups but trended the highest for Combat Gauze treated swine, followed by iTClamp plus XSTAT, iTClamp alone and finally iTClamp plus Combat Gauze. Conclusion: The results from this study demonstrate that the iTClamp can be effectively utilized in conjunction with hemostatic packing to control junctional hemorrhages.
Keywords: TClamp; hemorrhage; trauma; junctional wounds; hemostatic agent