Low-Titer Group O Whole-Blood Resuscitation in the Prehospital Setting in Israel: Review of the First 2.5 Years' Experience

Dan Levin; Maoz Zur; Eilat Shinar; Tzadok Moshe; Avishai M Tsur; Roy Nadler; Mark H Yazer; Danny Epstein; Guy Avital; Shaul Gelikas; Elon Glassberg; Avi Benov; Jacob Chen

doi:10.1159/000519623

Low-Titer Group O Whole-Blood Resuscitation in the Prehospital Setting in Israel: Review of the First 2.5 Years' Experience

Transfus Med Hemother. 2021 Oct 6;48(6):342-349. doi: 10.1159/000519623. eCollection 2021 Dec.

Authors

Dan Levin¹, Maoz Zur², Eilat Shinar^{3

4}, Tzadok Moshe^{3

4}, Avishai M Tsur^{1

5}, Roy Nadler^{1

6}, Mark H Yazer^{7

8}, Danny Epstein^{1

9}, Guy Avital^{1

10}, Shaul Gelikas¹, Elon Glassberg^{1

11

12}, Avi Benov^{1

11}, Jacob Chen^{1

13}

Affiliations

¹ Trauma and Combat Medicine Branch, Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel.
² Military Medical Academy, Medical Corps, Israel Defense Forces, Shefayim, Israel.
³ Magen David National Blood Services, Ramat Gan, Israel.
⁴ Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Scheva, Israel.
⁵ Department of Medicine B, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel.
⁶ Department of General Surgery and Transplantation - Surgery B, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Ramat Gan, Israel.
⁷ Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁸ Department of Pathology, Tel Aviv University, Tel Aviv, Israel.
⁹ Critical Care Division, Rambam Health Care Campus, Haifa, Israel.
¹⁰ Division of Anesthesia, Intensive Care and Pain Management, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
¹¹ The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
¹² The Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA.
¹³ Meir Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel.

Abstract

Introduction: The Israeli Defense Forces Medical Corps (IDF-MC) implemented the use of low-titer group O whole blood (LTOWB) as the first-choice resuscitation fluid in the IDF airborne Combat Search and Rescue Unit (IDF-CSAR) for aerial evacuation of both military and civilian casualties in June 2018 for injured patients with hemorrhagic shock and at least one of the following: systolic blood pressure <90 mm Hg, heart rate >130 beats/min, deterioration of consciousness without head injury or hemoglobin concentration ≤7 g/dL.

Method: All casualties treated with LTOWB by IDF-CSAR providers from June 2018 to January 2021 were included. Demographic and prehospital treatment data were collected in order to check compliance and adherence to the IDF-MC guidelines. This is a follow-up retrospective report.

Results: Overall, 1,608 LTOWB units were supplied to the IDF-CSAR during the study period. Of these, 33 were transfused to 27 casualties; 17 (69%) with blunt injury, 8 (29.6%) with penetrating injuries, and 1 (3.7%) with gastrointestinal bleeding without trauma. The leading cause of injury was motor vehicle accidents. A total of 23 casualties received 1 unit of LTOWB, 3 received 2 units and 1 patient received 4 units. Two casualties were children. The median heart rate was 120 beats/min, 8 (29.6%) casualties had heart rates >130 beats/min. Median systolic blood pressure was 95 mm Hg, 7 (26%) casualties had blood pressure <90 mm Hg. The median Glasgow Coma Score was 14. No adverse reactions were documented following the administration of LTOWB. 77.8% of patients received LTOWB in adherence to the guidelines.

Conclusion: Appropriate administration of LTOWB has improved over time in IDF-CSAR. Using LTOWB is feasible and simpler than administering packed red blood cells and plasma concurrently. Further efforts are needed to introduce LTOWB in other prehospital and in-hospital scenarios, with an increase in the maximum antibody titer threshold, to meet the expected increase in demand.

Keywords: Hemorrhagic shock; Low-titer O+ blood; Prehospital setting; Resuscitation; Whole blood.

Publication types

Review