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Review

Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

by
James H. Lantry
1,
Phillip Mason
2,
Matthew G. Logsdon
3,4,
Connor M. Bunch
3,4,
Ethan E. Peck
4,
Ernest E. Moore
5,
Hunter B. Moore
5,
Matthew D. Neal
6,
Scott G. Thomas
7,
Rashid Z. Khan
8,
Laura Gillespie
9,
Charles Florance
4,
Josh Korzan
4,
Fletcher R. Preuss
10,
Dan Mason
11,
Tarek Saleh
12,
Mathew K. Marsee
13,
Stefani Vande Lune
14,
Qamarnisa Ayoub
15,
Dietmar Fries
16 and
Mark M. Walsh
3,4,*add Show full author list remove Hide full author list
1
Department of Medicine Critical Care Services, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA
2
Department of Critical Care Medicine, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA
3
Department of Emergency Medicine, Indiana University School of Medicine—South Bend, Notre Dame, IN 46617, USA
4
Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA
5
Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO 80204, USA
6
Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
7
Department of Trauma Surgery, Memorial Leighton Trauma Center, Beacon Health System, South Bend, IN 46601, USA
8
Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN 46545, USA
9
Department of Quality Assurance and Performance Improvement, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA
10
Department of Orthopaedic Surgery, UCLA Santa Monica Medical Center and Orthopaedic Institute, Santa Monica, CA 90404, USA
11
Department of Medical Science and Devices, Haemonetics Corporation, Braintree, MA 02184, USA
12
Department of Critical Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA
13
Department of Graduate Medical Education, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
14
Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
15
Andeshgah Library, Kabul 1006, Afghanistan
16
Department of Surgical and General Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
 
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*
Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(2), 356; https://doi.org/10.3390/jcm11020356
Submission received: 21 December 2021 / Revised: 31 December 2021 / Accepted: 10 January 2022 / Published: 12 January 2022
(This article belongs to the Special Issue Diagnosis, Treatment and Management of Trauma-Induced Coagulation Disorder: Current Updates and Perspectives)
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Abstract

Modern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy—especially in austere or challenging environments—is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival.
Keywords: viscoelastic testing; far forward; austere environment; resuscitation; goal-directed therapy; whole blood; blood-component therapy viscoelastic testing; far forward; austere environment; resuscitation; goal-directed therapy; whole blood; blood-component therapy

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MDPI and ACS Style

Lantry, J.H.; Mason, P.; Logsdon, M.G.; Bunch, C.M.; Peck, E.E.; Moore, E.E.; Moore, H.B.; Neal, M.D.; Thomas, S.G.; Khan, R.Z.; et al. Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center. J. Clin. Med. 2022, 11, 356. https://doi.org/10.3390/jcm11020356

AMA Style

Lantry JH, Mason P, Logsdon MG, Bunch CM, Peck EE, Moore EE, Moore HB, Neal MD, Thomas SG, Khan RZ, et al. Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center. Journal of Clinical Medicine. 2022; 11(2):356. https://doi.org/10.3390/jcm11020356

Chicago/Turabian Style

Lantry, James H., Phillip Mason, Matthew G. Logsdon, Connor M. Bunch, Ethan E. Peck, Ernest E. Moore, Hunter B. Moore, Matthew D. Neal, Scott G. Thomas, Rashid Z. Khan, and et al. 2022. "Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center" Journal of Clinical Medicine 11, no. 2: 356. https://doi.org/10.3390/jcm11020356

APA Style

Lantry, J. H., Mason, P., Logsdon, M. G., Bunch, C. M., Peck, E. E., Moore, E. E., Moore, H. B., Neal, M. D., Thomas, S. G., Khan, R. Z., Gillespie, L., Florance, C., Korzan, J., Preuss, F. R., Mason, D., Saleh, T., Marsee, M. K., Vande Lune, S., Ayoub, Q., ... Walsh, M. M. (2022). Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center. Journal of Clinical Medicine, 11(2), 356. https://doi.org/10.3390/jcm11020356

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