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Early transfusion on battlefield before admission to role 2: A preliminary observational study during "Barkhane" operation in Sahel.
Injury. 2018 May; 49(5):903-910.I

Abstract

INTRODUCTION

Haemorrage is the leading cause of death after combat related injuries and bleeding management is the cornerstone of management of these casualties. French armed forces are deployed in Barkhane operation in the Sahel-Saharan Strip who represents an immense area. Since this constraint implies evacuation times beyond doctrinal timelines, an institutional decision has been made to deploy blood products on the battlefield and transfuse casualties before role 2 admission if indicated. The purpose of this study was to evaluate the transfusion practices on battlefield during the first year following the implementation of this policy.

MATERIALS AND METHODS

Prospective collection of data about combat related casualties categorized alpha evacuated to a role 2. Battlefield transfusion was defined as any transfusion of blood product (red blood cells, plasma, whole blood) performed by role 1 or Medevac team before admission at a role 2. Patients' characteristics, battlefield transfusions' characteristics and complications were analysed.

RESULTS

During the one year study, a total of 29 alpha casualties were included during the period study. Twenty-eight could be analysed, 7/28 (25%) being transfused on battlefield, representing a total of 22 transfusion episodes. The most frequently blood product transfused was French lyophilized plasma (FLYP). Most of transfusion episodes occurred during medevac. Compared to non-battlefield transfused casualties, battlefield transfused casualties suffered more wounded anatomical regions (median number of 3 versus 2, p = 0.04), had a higher injury severity score (median ISS of 45 versus 25, p = 0,01) and were more often transfused at role 2, received more plasma units and whole blood units. There was no difference in evacuation time to role 2 between patients transfused on battlefield and non-transfused patients. There was no complication related to battlefield transfusions. Blood products transfusion onset on battlefield ranged from 75 min to 192 min after injury.

CONCLUSION

Battlefield transfusion for combat-related casualties is a logistical challenge. Our study showed that such a program is feasible even in an extended area as Sahel-Saharan Strip operation theatre and reduces time to first blood product transfusion for alpha casualties. FLYP is the first line blood product on the battlefield.

Authors+Show Affiliations

French Medical Unit, Medical Centre of Lyon, France.French Military Medical Service, Operational Headquarters, France.Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France.French Medical Unit, Naval Special Operations Commandos Command, Lanester, France.French Military Medical Service, Operational Headquarters, France.French Military Blood Institute, Clamart, France.French Military Blood Institute, Clamart, France.Percy Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Clamart, France & Val de Grâce Military Academy, Paris, France.Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France.Sainte Anne Military Teaching Hospital, Anaesthesia and Intensive Care Unit, Toulon, France; 7th Paratrooper Forward Surgical Unit, France. Electronic address: bordes.julien@neuf.fr.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29248187

Citation

Vitalis, V, et al. "Early Transfusion On Battlefield Before Admission to Role 2: a Preliminary Observational Study During "Barkhane" Operation in Sahel." Injury, vol. 49, no. 5, 2018, pp. 903-910.
Vitalis V, Carfantan C, Montcriol A, et al. Early transfusion on battlefield before admission to role 2: A preliminary observational study during "Barkhane" operation in Sahel. Injury. 2018;49(5):903-910.
Vitalis, V., Carfantan, C., Montcriol, A., Peyrefitte, S., Luft, A., Pouget, T., Sailliol, A., Ausset, S., Meaudre, E., & Bordes, J. (2018). Early transfusion on battlefield before admission to role 2: A preliminary observational study during "Barkhane" operation in Sahel. Injury, 49(5), 903-910. https://doi.org/10.1016/j.injury.2017.11.029
Vitalis V, et al. Early Transfusion On Battlefield Before Admission to Role 2: a Preliminary Observational Study During "Barkhane" Operation in Sahel. Injury. 2018;49(5):903-910. PubMed PMID: 29248187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early transfusion on battlefield before admission to role 2: A preliminary observational study during "Barkhane" operation in Sahel. AU - Vitalis,V, AU - Carfantan,C, AU - Montcriol,A, AU - Peyrefitte,S, AU - Luft,A, AU - Pouget,T, AU - Sailliol,A, AU - Ausset,S, AU - Meaudre,E, AU - Bordes,J, Y1 - 2017/11/23/ PY - 2017/08/24/received PY - 2017/11/10/revised PY - 2017/11/22/accepted PY - 2017/12/19/pubmed PY - 2018/12/26/medline PY - 2017/12/18/entrez KW - Battlefield transfusion KW - Combat-related injury KW - French lyophilized plasma SP - 903 EP - 910 JF - Injury JO - Injury VL - 49 IS - 5 N2 - INTRODUCTION: Haemorrage is the leading cause of death after combat related injuries and bleeding management is the cornerstone of management of these casualties. French armed forces are deployed in Barkhane operation in the Sahel-Saharan Strip who represents an immense area. Since this constraint implies evacuation times beyond doctrinal timelines, an institutional decision has been made to deploy blood products on the battlefield and transfuse casualties before role 2 admission if indicated. The purpose of this study was to evaluate the transfusion practices on battlefield during the first year following the implementation of this policy. MATERIALS AND METHODS: Prospective collection of data about combat related casualties categorized alpha evacuated to a role 2. Battlefield transfusion was defined as any transfusion of blood product (red blood cells, plasma, whole blood) performed by role 1 or Medevac team before admission at a role 2. Patients' characteristics, battlefield transfusions' characteristics and complications were analysed. RESULTS: During the one year study, a total of 29 alpha casualties were included during the period study. Twenty-eight could be analysed, 7/28 (25%) being transfused on battlefield, representing a total of 22 transfusion episodes. The most frequently blood product transfused was French lyophilized plasma (FLYP). Most of transfusion episodes occurred during medevac. Compared to non-battlefield transfused casualties, battlefield transfused casualties suffered more wounded anatomical regions (median number of 3 versus 2, p = 0.04), had a higher injury severity score (median ISS of 45 versus 25, p = 0,01) and were more often transfused at role 2, received more plasma units and whole blood units. There was no difference in evacuation time to role 2 between patients transfused on battlefield and non-transfused patients. There was no complication related to battlefield transfusions. Blood products transfusion onset on battlefield ranged from 75 min to 192 min after injury. CONCLUSION: Battlefield transfusion for combat-related casualties is a logistical challenge. Our study showed that such a program is feasible even in an extended area as Sahel-Saharan Strip operation theatre and reduces time to first blood product transfusion for alpha casualties. FLYP is the first line blood product on the battlefield. SN - 1879-0267 UR - https://www.unboundmedicine.com/medline/citation/29248187/Early_transfusion_on_battlefield_before_admission_to_role_2:_A_preliminary_observational_study_during_"Barkhane"_operation_in_Sahel_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0020-1383(17)30821-5 DB - PRIME DP - Unbound Medicine ER -