Survey of group A plasma and low‐titer group O whole blood use in trauma resuscitation at adult civilian level 1 trauma centers in the US

Transfusion ◽  
2021 ◽  
Author(s):  
Mark H. Yazer ◽  
Philip C. Spinella ◽  
Vincent Anto ◽  
Nancy M. Dunbar
Keyword(s):  
Whole Blood ◽  
Trauma Centers ◽  
Trauma Resuscitation ◽  
The Us ◽  
Titer Group ◽  
Group A ◽  
Level 1

Fresh Whole Blood Transfusion: Military and Civilian Implications

2016 ◽  
Vol 36 (3) ◽  
pp. 50-57 ◽  
Author(s):  
Carl W. Goforth ◽  
John W. Tranberg ◽  
Phillip Boyer ◽  
Peter J. Silvestri
Keyword(s):  
Military Personnel ◽  
Whole Blood ◽  
Blood Collection ◽  
Preventable Death ◽  
Blood Components ◽  
Trauma Resuscitation ◽  
The Us ◽  
Wide Availability ◽  
Major Hurricane ◽  
Uncontrolled Hemorrhage

Uncontrolled hemorrhage and exsanguination are the leading cause of preventable death, and resuscitative therapy is a critical component for survival. In various combinations, fresh whole blood, blood components, colloids, and crystalloids have all been staples of trauma care. The use of fresh whole blood is a well-established military practice that has saved the lives of thousands of American and coalition military personnel. Civilian use of fresh whole blood is far less established owing to the wide availability of individual blood components. However, this highly tailored blood supply is vulnerable to both natural and man-made disasters. In the event of such disruption, such as a major hurricane, it may be necessary for civilian hospitals to rapidly enact a fresh whole blood program. Therefore, the aim of this article is to review the current use of blood therapy for trauma resuscitation, the US military’s approach to fresh whole blood, and how maintaining a civilian capacity for fresh whole blood collection in the event of future man-made and natural disasters is key to promoting survival from trauma.

Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers

2013 ◽  
Vol 3 (1) ◽  
pp. 88-92
Author(s):  
Daniel S Mangiapani ◽  
Bret C Peterson ◽  
Ryan Kellogg ◽  
Fraser J Leversedge
Keyword(s):  
Real Time ◽  
Improve Patient Care ◽  
Hand Surgery ◽  
Emergency Call ◽  
Trauma Centers ◽  
Level Ii ◽  
The Us ◽  
Level 1 ◽  
Level I ◽  
Microvascular Replantation

ABSTRACT Purpose The inconsistency of subspecialty emergency call services is a growing concern as declining reimbursements, increased legal risk, and challenging social and professional issues present a deterrent to call panel participation. This study assessed call availability of hand and microvascular replantation surgery at all level I and II trauma centers in the US. Materials and methods Between May and December 2010, all level I (n = 137) and level II (n = 153) trauma centers across the US were contacted by telephone. Phone contact was unannounced; responders were invited to participate in our IRBapproved anonymous survey regarding hand and microvascular replantation emergency coverage specific to their hospital. Results: Level 1 centers: 117 of 137 (85%) participated, of which 64 (54.7%) had immediate access for hand surgery and microvascular replantation services. Six hospitals provided services 15 to 31 days per month and 3 hospitals supported 1 to 15 days per month. Ten hospitals indicated an inconsistent coverage which was difficult to estimate and 34 hospitals reported no coverage. Level 2 centers 132 of 153 (86.3%) participated, of which 38 (29%) had immediate access for hand surgery and microvascular replantation services. Seven hospitals provided services 15 to 31 days per month and 3 hospitals for 1 to 15 days per month. 84 hospitals reported no specific coverage protocol. Conclusion Consistent on-call availability for emergency hand and microvascular replantation services remains a challenge across the US: • 54.7% of level I trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage; • 29% of level II trauma centers had immediate access to emergency hand and microvascular replantation services although many hospitals had intermittent coverage. Over 50% had no specific coverage protocol; • Many hospitals indicated the presence of subspecialty hand surgery coverage, however microvascular replantation resources were not available consistently; • While not confirmed, the current study findings suggest that a more clearly defined and coordinated system of hand surgery and microvascular replantation emergency call coverage will likely improve the efficiency of a limited resource and, ultimately, improve patient care. Peterson BC, Mangiapani DS, Kellogg R, Leversedge FJ. Hand and Microvascular Replantation Call Availability Study: A National Real-time Survey of Level 1 and 2 Trauma Centers. The Duke Orthop J 2013;3(1):88-92.

Clinical outcomes among low-titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation

Transfusion ◽  
2018 ◽  
Vol 58 (8) ◽  
pp. 1838-1845 ◽  
Author(s):  
Jansen N. Seheult ◽  
Vincent Anto ◽  
Louis H. Alarcon ◽  
Jason L. Sperry ◽  
Darrell J. Triulzi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Whole Blood ◽  
Trauma Resuscitation ◽  
Civilian Trauma ◽  
Titer Group

An evaluation of methods for producing low-titer group O whole blood to support military trauma resuscitation

2017 ◽  
Vol 82 ◽  
pp. S79-S86 ◽  
Author(s):  
Tamara R. Belin ◽  
Mark H. Yazer ◽  
Michael A. Meledeo ◽  
Roland L. Fahie ◽  
Wilbur W. Malloy ◽  
...  
Keyword(s):  
Whole Blood ◽  
Trauma Resuscitation ◽  
Military Trauma ◽  
Titer Group ◽  
Evaluation Of Methods

scholarly journals Survey to inform trial of low‐titer group O whole‐blood compared to conventional blood components for children with severe traumatic bleeding

Transfusion ◽  
2021 ◽  
Vol 61 (S1) ◽  
Author(s):  
Julia H. Kolodziej ◽  
Julie C. Leonard ◽  
Cassandra D. Josephson ◽  
Barbara A. Gaines ◽  
Stephen R. Wisniewski ◽  
...  
Keyword(s):  
Whole Blood ◽  
Blood Components ◽  
Titer Group ◽  
Traumatic Bleeding

scholarly journals An Evaluation of Morphological Changes and Deformability of Suspended Red Blood Cells Prepared Using Whole Blood with Different Hemoglobin Levels of Tibetans

2021 ◽  
pp. 1-10
Author(s):  
Rui Zhong ◽  
Dingding Han ◽  
Xiaodong Wu ◽  
Hong Wang ◽  
Wanjing Li ◽  
...  
Keyword(s):  
Red Blood Cells ◽  
Whole Blood ◽  
Blood Cells ◽  
Morphological Changes ◽  
Osmotic Fragility ◽  
Spherical Shape ◽  
Hypoxic Environment ◽  
Wide Range ◽  
Group A ◽  
Cell Membrane Protein

Background: The hypoxic environment stimulates the human body to increase the levels of hemoglobin (HGB) and hematocrit and the number of red blood cells. Such enhancements have individual differences, leading to a wide range of HGB in Tibetans’ whole blood (WB). Study Design: WB of male Tibetans was divided into 3 groups according to different HGB (i.e., A: >120 but ≤185 g/L, B: >185 but ≤210 g/L, and C: >210 g/L). Suspended red blood cells (SRBC) processed by collected WB and stored in standard conditions were examined aseptically on days 1, 14, 21, and 35 after storage. The routine biochemical indexes, deformability, cell morphology, and membrane proteins were tested. Results: Mean corpuscular volume, adenosine triphosphate, pH, and deformability were not different in group A vs. those in storage (p > 0.05). The increased rate of irreversible morphology of red blood cells was different among the 3 groups, but there was no difference in the percentage of red blood cells with an irreversible morphology after 35 days of storage. Group C performed better in terms of osmotic fragility and showed a lower rigid index than group A. Furthermore, SDS-PAGE revealed similar cross-linking degrees of cell membrane protein but the band 3 protein of group C seemed to experience weaker clustering than that of group A as detected by Western Blot analysis after 35 days of storage. Conclusions: There was no difference in deformability or morphological changes in the 3 groups over the 35 days of storage. High HGB levels of plateau SRBC did not accelerate the RBC change from a biconcave disc into a spherical shape and it did not cause a reduction in deformability during 35 days of preservation in bank conditions.

scholarly journals Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie A. Sewalt ◽  
Benjamin Y. Gravesteijn ◽  
Daan Nieboer ◽  
Ewout W. Steyerberg ◽  
Dennis Den Hartog ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Trauma Center ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Absolute Benefit ◽  
Predicted Probability ◽  
Prehospital Triage ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Level 2

Abstract Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.

scholarly journals Effect of the COVID-19 pandemic on the ability of level 1 trauma centers to meet American College of Surgeons research requirements

2021 ◽  
Vol 6 (1) ◽  
pp. e000692
Author(s):  
Robert M Madayag ◽  
Erica Sercy ◽  
Gina M Berg ◽  
Kaysie L Banton ◽  
Matthew Carrick ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
American College Of Surgeons ◽  
The Usa ◽  
Virus Exposure ◽  
Level 1 ◽  
Verification Process ◽  
Question Survey

IntroductionThe COVID-19 pandemic has had major effects on hospitals’ ability to perform scientific research while providing patient care and minimizing virus exposure and spread. Many non-COVID-19 research has been halted, and funding has been diverted to COVID-19 research and away from other areas.MethodsA 28-question survey was administered to all level 1 trauma centers in the USA that included questions about how the pandemic affected the trauma centers’ ability to fulfill the volume and research requirements of level 1 verification by the American College of Surgeons (ACS).ResultsThe survey had a 29% response rate (40/137 successful invitations). Over half of respondents (52%) reported reduced trauma admissions during the pandemic, and 7% reported that their admissions dropped below the volume required for level 1 verification. Many centers diverted resources from research during the pandemic (44%), halted ongoing consenting studies (33%), and had difficulty fulfilling research requirements because of competing clinical priorities (40%).DiscussionResults of this study show a need for flexibility in the ACS verification process during the COVID-19 pandemic, potentially including reduction of the required admissions and/or research publication volumes.Level of evidenceLevel IV, cross-sectional study.

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