How does Military Medicine learn lessons and overcome barriers in trauma resuscitation?

How have transfusion practices on the battlefield evolved?

Tune in and find out!   

Intro:  WarDocs had the pleasure of discussing the evolution of transfusion medicine on the battlefield with LTC(R) Philip C. Spinella, MD, a Professor in the Departments of Surgery and Critical Care Medicine and Co-director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. We delved into the history of blood transfusion practices during the Vietnam War, the shift from using whole blood to a mixture of red cells and crystalloids, and the lessons learned from Iraq and Afghanistan. We also explored the concept of damage control resuscitation, the transition from component therapy to whole blood therapy, and the barriers faced in developing high-level evidence through randomized controlled trials. Additionally, we touched on life-threatening hemorrhage in pediatric patients, the differences between adult and pediatric populations, and the future of therapy for life-threatening hemorrhage. Don't miss this fascinating episode highlighting the importance of having various tools in the "toolbox" to ensure the best care for patients experiencing life-threatening hemorrhage.

Chapters:

(0:00:00) - Transfusion Medicine on Battlefield

(0:09:12) - The Evolution of Hemostatic Resuscitation

(0:18:24) - Damage Control Resuscitation

(0:28:10) - Trauma Care

(0:37:08) - Precision Transfusion Medicine

Chapter Summaries:

(0:00:00) - Transfusion Medicine on Battlefield (9 Minutes)

In this episode, we explore the evolution of transfusion medicine on the battlefield with LTC(R) Philip C. Spinella, MD, a Professor in the Departments of Surgery and Critical Care Medicine and Co-director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. We discuss how strategies for hemostatic resuscitation have moved from component therapy to whole blood transfusion. Dr. Spinella shares his experiences deploying to Baghdad in 2004 and working with the 31st Combat Support Hospital.

(0:09:12) - The Evolution of Hemostatic Resuscitation (9 Minutes)

We dive into the history of blood transfusion practices during the Vietnam War and the shift from using whole blood to a mixture of red cells and crystalloids. The conversation highlights the lessons learned from Iraq and Afghanistan and the importance of keeping this knowledge alive for future conflicts. The discussion also covers the role of transfusion ratios in improving outcomes, the origin of the one-to-one-to-one ratio, and the use of recombinant activated factor VIIa in trauma resuscitation. Dr. Philip C Spinella shares the fascinating story behind these developments and the importance of considering a bundle of care for optimal patient outcomes.

(0:18:24) - Damage Control Resuscitation (10 Minutes)

We discuss the concept of damage control resuscitation and the transition from component therapy to whole blood therapy with the various barriers that needed to be overcome. Focusing on the importance of safety in transfusion medicine, we explore the challenges in developing high-level evidence through randomized controlled trials and the alternative approach of focused empiricism. We also examine the three main barriers to whole blood use in hemostatic resuscitation: ABO specificity, leukocyte reduction, and cold storage platelets.

(0:28:10) - Trauma Care (9 Minutes)

In this conversation, we examine life-threatening hemorrhages in pediatric patients and the differences between adult and pediatric populations. We discuss an NIH-sponsored prospective observational study that found a higher mortality rate in children with massive bleeding compared to adults. We also explore the types of whole blood, their nuances, and how they differ from component therapy. Additionally, we touch on the role of freeze-dried plasma in transfusion options and the current state of synthetic blood products. Ultimately, we emphasize the importance of having various tools in the "toolbox" to ensure the best care for patients experiencing life-threatening hemorrhage.

(0:37:08) - Precision Transfusion Medicine (9 Minutes)

We delve into the development of a dry artificial whole-blood product and its potential applications for various types of bleeding. This project, funded by DARPA, aims to create custom-made whole blood-like products specific to a patient's coagulopathy. We also discuss the challenges and barriers in conducting clinical trials in transfusion medicine, emphasizing the importance of funding, access to blood products, and the need for precision transfusion medicine. The conversation also touches on the future of therapy for life-threatening hemorrhage, focusing on metabolism-reducing agents to salvage patients in shock.

Episode Keywords:

Transfusion Medicine, Battlefield, Hemostatic Resuscitation, Whole Blood Therapy, Component Therapy, Damage Control Resuscitation, Vietnam War, Iraq and Afghanistan, Trauma Care, Life-Threatening Hemorrhage, Pediatric Patients, Blood Transfusion Practices, ABO Specificity, Leukocyte Reduction, Cold Storage Platelets, Freeze-Dried Plasma, Synthetic Blood Products, Precision Transfusion Medicine, Coagulopathy, Metabolism-Reducing Agents

#wardocs #military #medicine #podcast #TransfusionMedicine #BattlefieldMedicine #HemostaticResuscitation #WholeBloodTherapy #DamageControlResuscitation #PediatricHemorrhage #TransfusionResearch #MilitaryMedicine #BloodTransfusionEvolution #LifeSavingMedicine

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