More sophisticated than a drink cooler or an old sphygmomanometer but still not adequate for prehospital blood: A market review of commercially available equipment for prehospital blood transport and administration.
Journal
Transfusion
ISSN: 1537-2995
Titre abrégé: Transfusion
Pays: United States
ID NLM: 0417360
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
16
03
2021
received:
31
12
2020
accepted:
20
03
2021
entrez:
16
7
2021
pubmed:
17
7
2021
medline:
17
8
2021
Statut:
ppublish
Résumé
Hemorrhage is the leading cause of death in trauma patients with most fatalities occurring before reaching a higher level of care-this applies to both the civilian setting and the military combat setting. Hemostatic resuscitation with increased emphasis on blood transfusion while limiting use of crystalloids has become routine in trauma care. However, the prehospital setting-especially in combat-presents unique challenges with regard to storage, transport, and administration. We sought to evaluate available technology on the market for storage and administration technology that is relevant to the prehospital setting. We conducted a market review of available technology through subject-matter expert inquiry, reviews of published literature, reviews of Federal Drug Administration databases, internal military publications, and searches of Google. We reviewed and described a total of 103 blood transporters, 22 infusers, and 6 warmers. The risk of on-scene fatality in trauma patients and recent developments in trauma care demonstrate the need for prehospital transfusion. These transfusions have been logistically prohibited in many operations. We have reviewed the current commercially available equipment and recommended pursuit of equipment that improves accessibility to field transfusion. Current technology has limited applicability for the prehospital setting and is further limited for the military setting.
Sections du résumé
BACKGROUND
Hemorrhage is the leading cause of death in trauma patients with most fatalities occurring before reaching a higher level of care-this applies to both the civilian setting and the military combat setting. Hemostatic resuscitation with increased emphasis on blood transfusion while limiting use of crystalloids has become routine in trauma care. However, the prehospital setting-especially in combat-presents unique challenges with regard to storage, transport, and administration. We sought to evaluate available technology on the market for storage and administration technology that is relevant to the prehospital setting.
STUDY DESIGN AND METHODS
We conducted a market review of available technology through subject-matter expert inquiry, reviews of published literature, reviews of Federal Drug Administration databases, internal military publications, and searches of Google.
RESULTS
We reviewed and described a total of 103 blood transporters, 22 infusers, and 6 warmers.
CONCLUSIONS
The risk of on-scene fatality in trauma patients and recent developments in trauma care demonstrate the need for prehospital transfusion. These transfusions have been logistically prohibited in many operations. We have reviewed the current commercially available equipment and recommended pursuit of equipment that improves accessibility to field transfusion. Current technology has limited applicability for the prehospital setting and is further limited for the military setting.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
S286-S293Informations de copyright
© 2021 AABB. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
Références
Alarhayem AQ, Myers JG, Dent D, Liao L, Muir M, Mueller D, et al. Time is the enemy: mortality in trauma patients with hemorrhage from torso injury occurs long before the “golden hour”. Am J Surg. 2016;212:1101-5. https://doi.org/10.1016/j.amjsurg.2016.08.018.
National Academies of Sciences, Engineering, and Medicine. A national trauma care system: integrating military and civilian trauma systems to achieve zero preventable deaths after injury. Washington (DC): National Academies Press; 2016.
WISQARS (Web-based Injury Statistics Query and Reporting System) Injury Center|CDC, https://www.cdc.gov/injury/wisqars/index.html. Accessed 20 June 2020.
Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010;34:158-63. https://doi.org/10.1007/s00268-009-0266-1.
Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma. 2012;73(6, Supplement 5):S431-7.
Butler FK, Holcomb JB, Schreiber MA, Kotwal RS, Jenkins DA, Champion HR, et al. Fluid resuscitation for hemorrhagic shock in tactical combat casualty care: TCCC guidelines change 14-01-2 June 2014. J Spec Oper Med. 2014;14:13-38.
Thiels CA, Aho JM, Fahy AS, Parker ME, Glasgow AE, Berns KS, et al. Prehospital blood transfusions in non-trauma patients. World J Surg. 2016;40:2297-304. https://doi.org/10.1007/s00268-016-3572-4.
Wilcox CM, Cryer BL, Henk HJ, Zarotsky V, Zlateva G. Mortality associated with gastrointestinal bleeding events: comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting. Clin Exp Gastroenterol. 2009;2:21-30. https://doi.org/10.2147/ceg.s4936.
Callaghan WM, Kuklina EV, Berg CJ. Trends in postpartum hemorrhage: United States, 1994-2006. Am J Obstet Gynecol. 2010;202:353.e1-6. https://doi.org/10.1016/j.ajog.2010.01.011.
CDC. Quickstats: percentage of injury deaths for which death was pronounced outside the hospital. Morb Mortal Wkly. 2008;57(41):1130.
Eastridge BJ, Holcomb JB, Shackelford S. Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury. Transfusion. 2019;59(S2):1423-8. https://doi.org/10.1111/trf.15161.
Davis JS, Satahoo SS, Butler FK, Dermer H, Naranjo D, Julien K, et al. An analysis of prehospital deaths: who can we save? J Trauma Acute Care Surg. 2014;77:213-8. https://doi.org/10.1097/TA.0000000000000292.
Kotwal RS, Howard JT, Orman JA, Tarpey BW, Bailey JA, Champion HR, et al. The effect of a golden hour policy on the morbidity and mortality of combat casualties. JAMA Surg. 2016;151:15-24. https://doi.org/10.1001/jamasurg.2015.3104.
Floccard B, Rugeri L, Faure A, Denis MS, Boyle EM, Peguet O, et al. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury. 2012;43:26-32. https://doi.org/10.1016/j.injury.2010.11.003.
Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017;318:1581-91. https://doi.org/10.1001/jama.2017.15097.
Huang GS, Dunham CM. Mortality outcomes in trauma patients undergoing prehospital red blood cell transfusion: a systematic literature review. Int J Burns Trauma. 2017;7:17-26.
Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379:315-26. https://doi.org/10.1056/NEJMoa1802345.
Newberry R, Winckler CJ, Luellwitz R, et al. Prehospital transfusion of low-titer O + whole blood for severe maternal hemorrhage: a case report. Prehosp Emerg Care. 2020;24:566-75. https://doi.org/10.1080/10903127.2019.1671562.
Zhu CS, Pokorny DM, Eastridge BJ, et al. Give the trauma patient what they bleed, when and where they need it: establishing a comprehensive regional system of resuscitation based on patient need utilizing cold-stored, low-titer O+ whole blood. Transfusion. 2019;59(S2):1429-38. https://doi.org/10.1111/trf.15264.
Parker ME, Khasawneh MA, Thiels CA, et al. Prehospital transfusion for gastrointestinal bleeding. Air Med J. 2017;36:315-9. https://doi.org/10.1016/j.amj.2017.06.002.
Stubbs JR, Zielinski MD, Jenkins D. The state of the science of whole blood: lessons learned at Mayo Clinic. Transfusion. 2016;56(Suppl 2):S173-81. https://doi.org/10.1111/trf.13501.
Mapp JG, Bank EA, Osborn LA, et al. Epidemiological and accounting analysis of ground ambulance whole blood transfusion. Prehosp Disaster Med. 2020;35:98-103. https://doi.org/10.1017/S1049023X1900517X.
Strandenes G, Berséus O, Cap AP, Hervig T, Reade M, Prat N, et al. Low titer group O whole blood in emergency situations. Shock. 2014;41(Suppl 1):70-5. https://doi.org/10.1097/SHK.0000000000000150.
Fisher AD, Dunn J, Pickett JR, Garza J, Miles EA, Diep V, et al. Implementation of a low titer group O whole blood program for a law enforcement tactical team. Transfusion. 2020;60(Suppl 3):S36-44. https://doi.org/10.1111/trf.15625.
Strandenes G, Austlid I, Apelseth TO, et al. Coagulation function of stored whole blood is preserved for 14 days in austere conditions: a ROTEM feasibility study during a Norwegian antipiracy mission and comparison to equal ratio reconstituted blood. J Trauma Acute Care Surg. 2015;78(6 Suppl 1):S31-8. https://doi.org/10.1097/TA.0000000000000628.
Bjerkvig C, Sivertsen J, Braathen H, et al. Cold-stored whole blood in a Norwegian emergency helicopter service: an observational study on storage conditions and product quality. Transfusion. 2020;60(7):1544-1545. https://doi.org/10.1111/trf.15802.
Yazer MH, Spinella PC, Allard S, et al. Vox Sanguinis international forum on the use of prehospital blood products and pharmaceuticals in the treatment of patients with traumatic haemorrhage. Vox Sang. 2018;113:701-6. https://doi.org/10.1111/vox.12678.
World Health Organization. The blood cold chain guide to the selection and procurement of equipment and accessories. Geneva, Switzerland: World Health Organization; 2002;561.
Food and Drug Administration. Establishment registration & device listing. 2019. https://www.accessdata.fda.gov. Accessed 31 Jun 2020
Konert A, Smereka J, Szarpak L. The use of drones in emergency medicine: practical and legal aspects. Emerg Med Int. 2019;2019:1-4. https://doi.org/10.1155/2019/3589792.
Ling G, Draghic N. Aerial drones for blood delivery. Transfusion. 2021;59(52):1-2. https://doi.org/10.1111/trf.15195.
Gilmore CK, Gilmore CK, Chaykowsky M, Chaykowsky M, Thomas B, Thomas B. Autonomous unmanned aerial vehicles for blood delivery: A UAV fleet design tool and case study 2019
Golden Hour™ Mobile Series 4 2L|Pelican BioThermal. https://pelicanbiothermal.com/products/golden-hour-mobile-series-4-2. Accessed 31 Jun 2020
Golden Hour™ Medic Series 4|Pelican BioThermal. https://pelicanbiothermal.com/products/golden-hour-medic-series-4. Accessed 31 Jul 2020
CSWB-2U Golden Minute Container. 2020 https://www.bloodstonedivision.com/products/cswb-2u-golden-minute-container. Accessed 12 Oct 2020
Blood Boxx Tactical Combat Medical Systems Harrisburg, NC. 2020 https://combatmedical.com/product/bloodboxx-tactical. Accessed 31 Jun 2020
High-performance controlled temperature carriers. http://www.kooltuubz.com. Accessed 12 Oct 2020.
Pelican BioThermal Blood supply thermal shippers. https://www.Pelicanbiothermal.com. Accessed 31 Jul 2020.
ThermoSafe Insulated shippers and refrigerants-cold chain packaging. https://www.thermosafe.com. Accessed 31 Jul 2020.
Cold boxes manufacturer. Blowkings-Cold chain equipments. 2020 https://www.blowkings.co.in/cold-boxes-manufacturer.html. Accessed 31 Jul 2020
Bmedicalsystems.com. https://www.bmedicalsystems.com/wp-content/uploads/2019/07/B-Medical-Systems_Transport-Boxes_EN.pdf. Accessed 31 Jun 2020.
72 hours duration validated cold chain system and box for vaccines and medicine transport and storage http://medicalpolarbox.com/medical-cooler/72-hours-duration-validated-cold-chain-system.html. Accessed 31 Jul 2020.
BioFridge. 2020 http://www.biofridge.com. Accessed 09 Aug 2020.
FridgeFreeze. http://fridgefreeze.com. Accessed 09 Aug 2020
Portable Medical Refrigerators Freezers|Roemer Industries. 2020 https://roemerindustries.com. Accessed 09 Aug 2020.
Products-EMIT Corporation. https://www.emitcorp.com/products.html. Accessed 31 Jun2020
The Warrior Modular System. https://qinflow.com/Products. Accessed 31 Jun 2020.
MEQU|Blood warming. 2020 https://mequ.dk. Accessed 31 Jun 2020.
LifeWarmer|Highest Technologies. Simplest solutions https://www.lifewarmer.com/. Accessed 30 Jun 2020.
Buddy Lite-Portable IV & Infusion Pump|Belmont Medical. Belmontmedtech.com. https://belmontmedtech.com/portable-iv-pump. Accessed 31 Jun 2020.
Thermalangel.com. https://thermalangel.com/products/thermal-angel-ta-200. Accessed 31 Jun 2020.
Buddy lite™ blood & fluid warmer instructional video-full. 2020 https://youtu.be/8V8cRaTPRLw. Accessed 31 Jun 2020.
U.S. Food and Drug Administration FDA's recall for the enflow fluid warming system, https://www.fda.gov/medical-devices/medical-device-recalls/vyaire-medical-recalls-enflow-fluid-warming-system-disposable-cartridges-due-potential-risk-exposure. Accessed 15 Jul 2020.
Shamim F, Abbasi S. Fatal vascular air embolism during fluid resuscitation as a complication of pressure infuser bag. J Emerg Trauma Shock. 2016. 2016;9:46-7. https://doi.org/10.4103/0974-2700.161659.
How It Works|LifeFlow. 2020 https://410medical.com/about/how-it-works. Accessed 02 Aug 2020.
Mobile IV Systems. https://mobileivsystems.com/. Accessed 30 Jun 2020.
Biegler Autopress. https://www.biegler.com/en/autopress. Accessed 30 Jun 2020.
Zoll Power Infuser. 2020 https://www.zoll.com/medical-products/fluid-resuscitation/power-infuser-pump. Accessed 02 Aug 2020.