Podcast Episode 29: Dr. Cap on Fresh Whole Blood and Resuscitation for PFC
Dr. Cap has been leading the way here in the US with the Armed Services Blood Program on fresh whole blood transfusion research in conjunction with the THOR Network and answering tough questions that different Special Operations Units come up with when analyzing how best to implement a fresh whole blood resuscitation protocol. In this episode Dennis presses him on the important resuscitation questions medics everywhere seem to be asking :
- I don’t have blood yet; Crystalloid isn’t really that bad, is it?
- Can’t I just resuscitate to a normal BP with hetastarch or hextend?
- Where does FDP fit in with resuscitation?
- What do you mean by, “dose of shock?”
- Do I really have to give TXA over 10 minutes?
- What comes first TXA, Calcium or Blood?
- Why should patients get calcium as soon as possible once you identify they need blood?
- What’s this about pre-hospital albumin?
Once you listen to the episode and want to start doing more research into bringing FWB to your unit, check out this great post by our affiliates over at Next Generation Combat Medic. They have gathered the majority of the current and relevant research so that you can intelligently discuss starting the program with your PA, Surgeon or Medical Director.
…then go to the Armed Services Blood Program and set up a date to get your guys typed and titered before your next deployment.
Check out our previous written FAQ with Dr. Cap:
THOR PFC Fresh Whole Blood Transfusion FAQ’s Dr. Cap part1
Here is our Previous Podcast and post from Geir Strandenes, also of the THOR network recorded live from SOMSA17:
Are you familiar with the concept of oxygen debt or oxygen deficit? What constitutes a “dose” of shock? What systolic BP constitutes hypotension on the battlefield? Where did the concept of permissive hypotension come from? Is it still valid? How long can fresh whole blood last?
Blood Transfusions were a huge topic at this year’s meeting in Charlotte with no less than 3 major speakers giving multiple talks on the subject. This talk was recorded during the Prolonged Field Care Pre-Conference Lab during the Special Operations Medicine and Scientific Assembly (SOMSA). Dr. Geir Strandenes is a founding member of the THOR (Tactical Hemostasis, Oxygenation, and Resuscitation) Group, the Senior Medical Officer of the Norwegian Naval Special Operations, and a Researcher in the Department of Immunology and Transfusion Medicine at Haukeland University Hospital in Bergen, Norway. He has worked hand-in-hand with the U.S. Army Institute of Surgical Research and the US Armed Forces Blood Program. You can read more about his research and other articles at www.RDCR.org. Our PFC working group has always gone to the THOR network with any blood questions that we have, as they usually have an answer or best practice already established. I have included a link to the THOR/RDCR.org publication page below along with other notable publications which he helped to author such as the recently published JTS ISR Clinical Practice Guideline on Damage Control Resuscitation and the Frequently Asked Questions we sent to Geir and the THOR network over the last couple years.
Here are some notable quotes from the episode:
- Understanding physiology is the most important thing.
- Salt water is for cooking pasta blood is for resuscitation.
- A low urine output is one thing that will keep me awake at night in the ICU.
- Blood pressure does not equal perfusion.
- We can’t escape Fick’s equation DO2 = 1.34 x Hb x SaO2 x CO
- Hypotensive resuscitation is a problem in the prolonged field care setting because you die from shock dose.
- Permissive hypotension is not a treatment it’s a hemostatic procedure.
- A systolic blood pressure below 100 on the battlefield is hypotension.
- Once you give Type-O continue giving Type-O, not Type-Specific (Anything after ~4 Units)
- Don’t cling to a mistake just because you spent a long time making it.
Listen to episode 22 Now:
Here are the slides I was able to get pictures of using the Microsoft Lens App:
Here are just a few of his publications:
Tactical Damage Control Resuscitation Military Medicine 2015
Remote Damage Control Resuscitation Field Donor Triage
THOR PFC Fresh Whole Blood Transfusion FAQ’s part1 Dr. Cap (December, 2014)
THOR PFC Fresh Whole Blood Transfusion FAQ’s part 2 Dr. Strandenes (2016)
Advances in the Use of Whole Blood in Combat Resuscitation
Damage Control Resuscitation ISR CPG 03Feb2017
Check out these other great podcasts on the subject of blood and resuscitation by Doc Rush of the PJ Medcast:
Dr. Cap recommends early calcium replacement in a patient who is receiving or will be recieving FWB resuscitation secondary to hemorrhagic shock, an appropriate treatment. However, in the field, most forward deployed personnel will have little to no access to lab capabilities. My question is in a patient with hemorrhagic shock, what are safe guidelines for calcium use in the field? How much is too much and what signs/symptoms are you looking for?