Ranger O Low Titer (ROLO): Whole Blood Transfusion for Forward Deployed Units

ABSTRACT First-time use of Ranger O Low Titer (ROLO) blood and implementation of a forward-walking blood bank using predetermined donors proved essential in the survival of a 33-year-old active duty soldier following a complex blast injury during combat operations. The patient sustained significant bone, soft tissue, and vascular damage and continued to deteriorate despite resuscitation with cold-stored whole blood (WB). Only after utilizing the ROLO battle drill and transfusing with fresh WB was the patient able to be stabilized and evacuated. In this case report, we discuss how ROLO walking blood bank takes the next step in aiding resuscitation, providing smaller, forward-deployed units with blood resupply without the administrative burden of storage, particularly in resource-scarce environments. We provide an overview of WB and contrast its use to that of component therapy. In conjunction with the Golden Hour, ROLO can be incorporated as the standard damage control resuscitation to reduce the risks of noncompressible hemorrhage. By taking precautionary steps in the pre-deployment setting, ROLO offers an invaluable alternative to conventional resuscitation.

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The Light Role CCP: A Blueprint for Far Forward Medical Support to Contemporary Operations

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001435 ◽

2020 ◽

Vol 166 (6) ◽

pp. 433-438

Author(s):

John Miles ◽

C Jones

Keyword(s):

Gunshot Wound ◽

Damage Control ◽

Blast Injury ◽

Damage Control Resuscitation ◽

Emergency Medical Care ◽

Blood Products ◽

Front Line ◽

Medical Support ◽

The Uk ◽

Early Damage

November 2018 saw the deployment of a medical team with a remit to provide far forward medical support to UK, Coalition and indigenous forces. The delivery of this capability demanded a solution unique within the UK Defence Medical Services. The ‘light role’ casualty collection points provided emergency medical care to 475 casualties over a 4-month period. The success of the deployment was dependant on the ability to remain light and agile which brought with it logistical considerations. The clinical caseload was predominantly secondary blast injury and gunshot wound (GSW). The positioning of a Role 1 facility close to the front line of troops enabled early Damage Control Resuscitation including the delivery of blood products. MEDEVAC to Role 2 was enabled by indigenous forces. The unique situation demanded bespoke solutions for documentation and blood warming. The lessons learnt during the deployment may form a blueprint for future contingency operations.

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First-time use of bevacizumab for aggressive, metastatic hepatocellular carcinoma in an HIV/hepatitis B virus coinfected patient: a case report

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0b013e3282f16411 ◽

2008 ◽

Vol 20 (5) ◽

pp. 472-473 ◽

Cited By ~ 5

Author(s):

Ioannis G. Baraboutis ◽

Vassilios Papastamopoulos ◽

Georgios Charitsis ◽

Lazaros J. Lekakis ◽

Michael M. Vaslamatzis ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Case Report ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Time Use ◽

B Virus ◽

Metastatic Hepatocellular Carcinoma ◽

Coinfected Patient ◽

First Time

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A Novel Cross-Linked Hemoglobin-Based Oxygen Carrier, YQ23, Extended the Golden Hour for Uncontrolled Hemorrhagic Shock in Rats and Miniature Pigs

Frontiers in Pharmacology ◽

10.3389/fphar.2021.652716 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lei Kuang ◽

Yu Zhu ◽

Yue Wu ◽

Kunlun Tian ◽

Xiaoyong Peng ◽

...

Keyword(s):

Side Effects ◽

Hemorrhagic Shock ◽

Damage Control ◽

Oxygen Carrier ◽

Organ Injury ◽

Damage Control Resuscitation ◽

Organ Function ◽

Golden Hour ◽

Animal Survival ◽

Hypotensive Resuscitation

Background: Hypotensive resuscitation is widely applied for trauma and war injury to reduce bleeding during damage-control resuscitation, but the treatment time window is limited in order to avoid hypoxia-associated organ injury. Whether a novel hemoglobin-based oxygen carrier (HBOC), YQ23 in this study, could protect organ function, and extend the Golden Hour for treatment is unclear.Method: Uncontrolled hemorrhagic shock rats and miniature pigs were infused with 0.5, 2, and 5% YQ23 before bleeding was controlled, while Lactate Ringer’s solution (LR) and fresh whole blood plus LR (WB + LR) were set as controls. During hypotensive resuscitation the mean blood pressure was maintained at 50–60 mmHg for 60 min. Hemodynamics, oxygen delivery and utilization, blood loss, fluid demand, organ function, animal survival as well as side effects were observed. Besides, in order to observe whether YQ23 could extend the Golden Hour, the hypotensive resuscitation duration was extended to 180 min and animal survival was observed.Results: Compared with LR, infusion of YQ23 in the 60 min pre-hospital hypotensive resuscitation significantly reduced blood loss and the fluid demand in both rats and pigs. Besides, YQ23 could effectively stabilize hemodynamics, and increase tissue oxygen consumption, increase the cardiac output, reduce liver and kidney injury, which helped to reduce the early death and improve animal survival. In addition, the hypotensive resuscitation duration could be extended to 180 min using YQ23. Side effects such as vasoconstriction and renal injury were not observed. The beneficial effects of 5% YQ23 are equivalent to similar volume of WB + LR.Conclusion: HBOC, such as YQ23, played vital roles in damage-control resuscitation for emergency care and benefited the uncontrolled hemorrhagic shock in the pre-hospital treatment by increasing oxygen delivery, reducing organ injury. Besides, HBOC could benefit the injured and trauma patients by extending the Golden Hour.

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Case Report: Paroxysmal Nocturnal Hemoglobinuria with the Development of Aplastic Anemia

Blood ◽

10.1182/blood.v8.7.664.664 ◽

1953 ◽

Vol 8 (7) ◽

pp. 664-670 ◽

Cited By ~ 15

Author(s):

M. G. NELSON ◽

J. H. BRUCE

Keyword(s):

Case Report ◽

Blood Transfusion ◽

Aplastic Anemia ◽

Whole Blood ◽

Paroxysmal Nocturnal Hemoglobinuria ◽

Red Cells ◽

First Time ◽

Therapeutic Administration ◽

Transfusion Reactions

Abstract 1. A case of paroxysmal nocturnal hemoglobinuria is presented which developed hemoglobinuria for the first time while in the hospital and showed severe reactions to whole blood transfusion but none to washed red cells. 2. Therapeutic administration of heparin induced severe hemoglobinuric episodes which were followed by a remission in the transfusion reactions to whole blood. 3. Later, aplastic anemia developed with a marked subsidence in the various indicators of the hemolytic process although the erythrocytic defect found in paroxysmal nocturnal hemoglobinuria was still present.

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Damage Control Resuscitation Using Warm Fresh Whole Blood: A Paramount Role for Leukocytes and Derived Microparticles in the Prevention of Coagulation Abnormalities?

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3181d4890a ◽

2010 ◽

Vol 68 (5) ◽

pp. 1266-1267 ◽

Cited By ~ 2

Author(s):

Nicolas Morel ◽

François Delaunay ◽

Philippe Dabadie ◽

Gerlinde Averous ◽

Olivier Morel

Keyword(s):

Whole Blood ◽

Damage Control ◽

Damage Control Resuscitation ◽

Coagulation Abnormalities

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Emergency sternal intraosseous access for warm fresh whole blood transfusion in damage control resuscitation

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000001850 ◽

2018 ◽

Vol 84 ◽

pp. S120-S124 ◽

Cited By ~ 9

Author(s):

Christopher Kalhagen Bjerkvig ◽

Theodor Kaurin Fosse ◽

Torunn Oveland Apelseth ◽

Joar Sivertsen ◽

Hanne Braathen ◽

...

Keyword(s):

Blood Transfusion ◽

Whole Blood ◽

Damage Control ◽

Damage Control Resuscitation ◽

Intraosseous Access

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Whole Blood for Blood Loss: Hemostatic Resuscitation in Damage Control

10.25100/cm.v51i4.4511 ◽

2020 ◽

Author(s):

Juan Carlos Salamea ◽

Amber Himmler ◽

Laura Isabel Valencia-Angel ◽

Carlos Alberto Ordoñez ◽

Michael Parra ◽

...

Keyword(s):

Hemorrhagic Shock ◽

Whole Blood ◽

Damage Control ◽

Fresh Frozen Plasma ◽

Trauma Patients ◽

Damage Control Resuscitation ◽

Middle Income ◽

Packed Red Blood Cells ◽

Hemostatic Resuscitation ◽

Fresh Frozen

Hemorrhagic shock and its complications are a major cause of death among trauma patients. The management of hemorrhagic shock using a damage control resuscitation strategy has been shown to decrease mortality and improve patient outcomes. One of the components of damage control resuscitation is hemostatic resuscitation, which involves the replacement of lost blood volume with components such as packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets in a 1:1:1:1 ratio. However, this is a strategy that is not applicable in many parts of Latin America and other low-and-middle-income countries throughout the world, where there is a lack of well-equipped blood banks and an insufficient availability of blood products. To overcome these barriers, we propose the use of cold fresh whole blood for hemostatic resuscitation in exsanguinating patients. Over 6 years of experience in Ecuador has shown that resuscitation with cold fresh whole blood has similar outcomes and a similar safety profile compared to resuscitation with hemocomponents. Whole blood confers many advantages over component therapy including, but not limited to the transfusion of blood with a physiologic ratio of components, ease of transport and transfusion, less volume of anticoagulants and additives transfused to the patient, and exposure to fewer donors. Whole blood is a tool with reemerging potential that can be implemented in civilian trauma centers with optimal results and less technical demand.

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THE CONCEPT OF DAMAGE CONTROL RESUSCITATION (DCR) IN THE PREHOSPITAL AS WELL AS IN-HOSPITAL SETTING – A CASE REPORT

Emergency Medical Service ◽

10.36740/emems202003113 ◽

2020 ◽

Vol 7 (3) ◽

pp. 239-242

Author(s):

Wojciech Stefaniak ◽

Łukasz Rozbicki

Keyword(s):

Emergency Department ◽

Case Report ◽

Trauma Center ◽

Damage Control ◽

Hospital Setting ◽

Medical Team ◽

Damage Control Resuscitation ◽

Hospital Level ◽

Emergency Medical Team ◽

Resuscitation Strategy

The aim of the study was to present the principles of the “damage control resuscitation” strategy based on a case report of a patient with multi-organ trauma at the pre-hospital and in-hospital settings. In addition to the fastest possible implementation of care at the pre-hospital level, a very important factor influencing the effectiveness of actions is the decision of the head of the emergency medical team to choose the place of transport of the patient (the nearest poviat Emergency Department or a remote Trauma Center). This should be conditioned not only by anatomical injuries and physiological parameters of the victim, but also other elements, depending on local possibilities.

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