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

James H. Lantry, 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, Laura Gillespie, Charles Florance, Josh Korzan, Fletcher R. Preuss, Dan Mason, Tarek Saleh, Mathew K. Marsee, Stefani Vande Lune, Qamarnisa Ayoub, Dietmar FriesMark M. Walsh

Producción científica: Review articlerevisión exhaustiva

7 Citas (Scopus)

Resumen

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.

Idioma originalEnglish (US)
Número de artículo356
PublicaciónJournal of Clinical Medicine
Volumen11
N.º2
DOI
EstadoPublished - ene 1 2022
Publicado de forma externa

ASJC Scopus subject areas

  • General Medicine

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