The U.S. Armed Services Blood Program support to U.S. Central Command 2014–2021: Transformation of combat trauma resuscitation through blood product innovation and expansion of blood availability far forward

Audra L. Taylor, Jason B. Corley*, Andrew P. Cap, Matthew T. Swingholm, Erika T. Nance*, Richard Gonzales, Jennifer M. Gurney, Stacey Shackelford, Jeffrey C. Hebert, Jessica D. Hughes, Karen Royster, George A. Hestilow, Colleen L. Cordrick, Jonathan Hoiles, Kathleen Whitlock, Robin Whitacre, Becky Pederson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: The United States Armed Services Blood Program (ASBP) faced complex blood supply challenges during two decades of military operations in the U.S. Central Command (CENTCOM) and through an adaptive, responsive, and agile system, gained valuable insights on blood product usage in combat casualty care. Study Design and Methods: A retrospective review of blood product introduction and utilization trends was compiled from ASBP data collected during CENTCOM operations from 2014 through 2021. Results: During the study period, several blood products were introduced to the CENTCOM area of operations including Low Titer O Whole Blood (LTOWB), Cold-Stored Platelets (CSP), Liquid Plasma (LP), and French Freeze Dried Plasma (FDP) manufactured from U.S. sourced donor plasma, all while expanding Walking Blood Bank capabilities. There was a gradual substitution of component therapy for whole blood; blood utilization peaked in 2017. Transfusion of Fresh Whole Blood (FWB) from Walking Blood Banks decreased as fully pre-tested LTOWB was supplied by the ASBP. LTOWB was initially supplied in citrate–phosphate-dextrose (CPD) anticoagulant (21-day shelf life) but was largely replaced with LTOWB in citrate–phosphate-dextrose-adenine (CPDA-1) anticoagulant (35-day shelf life) by 2019. Implementation of prehospital transfusion and expansion of surgical and resuscitation teams led to an increase in the number of sites receiving blood. Discussion: ASBP introduced new products to its inventory in order to meet changing blood product demands driven by changes in the Joint Trauma System Clinical Practice Guidelines and operational demands. These products were adopted into clinical practice with a resultant evolution in transfusion strategies.

Original languageEnglish
Pages (from-to)167-S176
JournalTransfusion
Volume62
Issue numberS1
DOIs
StatePublished - Aug 2022
Externally publishedYes

Keywords

  • Armed Services Blood Program
  • cold-stored platelets
  • combat trauma
  • freeze-dried plasma
  • liquid plasma
  • low titer group o whole blood
  • prehospital transfusion
  • walking blood bank

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