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This week's featured articles


Prescreened Whole O Blood Group Walking Blood Bank Capabilities for Nontraditional Maritime Medical Receiving Platforms: A Case Series


Chang R, Boyle BP, Udoh MO, Maestas JM, Gehrz JA, Ruano E, Banker L, Cap AP, Bitterman JW, Deaton TG, Auten JD. 24(1). 60 - 66. (Journal Article)


Background: Tactical Combat Casualty Care (TCCC) guidelines recognize low-titer group O whole blood (LTOWB) as the resuscitative fluid of choice for combat wounded. Utilization of prescreened LTOWB in a walking blood bank (WBB) format has been well described by the Ranger O low-titer blood (ROLO) and the United States Marine Corps Valkyrie programs, but it has not been applied to the maritime setting. Methods: We describe three WBB experiences of an expeditionary resuscitative surgical system (ERSS) team, attached to three nontraditional maritime medical receiving platforms, over 6 months. Results: Significant variations were identified in the number of screened eligible donors, the number of LTOWB donors, and the timely arrival at WBB activation sites between the platforms. Overall, 95% and 84% of the screened eligible group O blood donors on the Arleigh Burke Class Destroyer (DDG) and Nimitz Class Aircraft Carrier (CVN), respectively, were determined to be LTOWB. However, only 37% of the eligible screened group O blood donors aboard the Harper's Ferry Class Dock Landing Ship (LSD) were found to be LTOWB. Of the eligible donors, 66% did not complete screening, with 52% citing a correctable reason for nonparticipation. Conclusion: LTOWB attained through WBBs may be the only practical resuscitative fluid on maritime platforms without inherent blood product storage capabilities to perform remote damage control resuscitation. Future efforts should focus on optimizing WBBs through capability development, education, and training efforts.

Keywords: Low titer O; whole blood transfusion; damage control resuscitation; distributed maritime operations; walking blood bank

PMID: 38408045


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The Use of Tourniquets in the Russo-Ukrainian War


Samarskiy IM, Khoroshun EM, Vorokhta Y. 24(1). 67 - 70. (Journal Article)


Aim: The objective of the study was to evaluate the use of tourniquets in the Russo-Ukrainian war. Methods: The type, number, and duration of tourniquets per limb, the clinical course of limb injuries, and the functional status of the injured limbs during the 24 hours post-injury were evaluated in military hospital facilities for the period of 2014-2022. Statistical frequencies and variances were analyzed. Results: During active hostilities, the medical units of the Southern Operational Command received 2,496 patients with limb injuries that required the application of tourniquets. Lower extremity injuries were predominantly observed (84.4%). A single tourniquet was used in 1,538 cases (61.6%), whereas two tourniquets were used in 533 (21.4%), and three tourniquets in 425 cases (17.0%). During the 2014- 2021 period, Esmarch's tourniquet was most commonly used. However, in 2022, it was mostly replaced by the Combat Application Tourniquet and similar systems (e.g., Sich, Dnipro). The duration of the tourniquet use ranged from 50 to 380 minutes (mean 205.9 [standard error 8.1] min), which prolonged ischemia in a significant number of cases. Limb amputations, mainly due to extensive necrosis, were performed in 92 cases (3.7%). In addition to 101 deaths (4.0% of patients), 11 cases of severe tourniquet syndrome were encountered. The limb was salvaged in 9 cases (81.8%). Conclusion: Prompt triage and evacuation of injured combatants can save affected limbs, even when the duration of tourniquet use exceeds 2 hours. Tourniquet syndrome can be prevented using a hemostatic tourniquet.

Keywords: tactical medicine; limb injury; tourniquets; vascular surgery; Russo-Ukrainian war

PMID: 38408044


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