Fluid Resuscitation in Tactical Combat Casualty Care TCCC Guidelines Change 21-01 4 November 2021

Travis Deaton, Jonathan Auten, Richard Betzold, Frank Butler, Terence Byrne, Andre Cap, Ben Donham, Joseph Dubose, Andrew D. Fisher, James Hancock, Victor Jourdain, Ryan Knight, Lanny Littlejohn, Matthew Martin, Kevin Toland, Brendon Drew

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Hemorrhagic shock in combat trauma remains the greatest life threat to casualties with potentially survivable injuries. Advances in external hemorrhage control and the increasing use of damage control resuscitation have demonstrated significant success in decreasing mortality in combat casualties. Presently, an expanding body of literature suggests that fluid resuscitation strategies for casualties in hemorrhagic shock that in-clude the prehospital use of cold-stored or fresh whole blood when available, or blood components when whole blood is not available, are superior to crystalloid and colloid fluids. On the basis of this recent evidence, the Committee on Tactical Combat Casualty Care (TCCC) has conducted a review of fluid resuscitation for the combat casualty who is in hemor-rhagic shock and made the following new recommendations: (1) cold stored low-titer group O whole blood (CS-LTOWB) has been designated as the preferred resuscitation fluid, with fresh LTOWB identified as the first alternate if CS-LTOWB is not available; (2) crystalloids and Hextend are no longer rec-ommended as fluid resuscitation options in hemorrhagic shock; (3) target systolic blood pressure (SBP) resuscitation goals have been redefined for casualties with and without traumatic brain injury (TBI) coexisting with their hemorrhagic shock; and (4) empiric prehospital calcium administration is now recom-mended whenever blood product resuscitation is required.

Original languageEnglish
Pages (from-to)126-137
Number of pages12
JournalJournal of Special Operations Medicine
Issue number4
StatePublished - 1 Dec 2021
Externally publishedYes


  • blood transfusion
  • calcium
  • damage control resuscitation
  • fluid resuscitation
  • hemorrhage
  • shock
  • traumatic brain injury
  • traumatic injury


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