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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

2022; Multidisciplinary Digital Publishing Institute; Volume: 11; Issue: 2 Linguagem: Inglês

10.3390/jcm11020356

2077-0383

James Lantry, Phillip E. Mason, Matthew G. Logsdon, Connor M. Bunch, Ethan E. Peck, Ernest E. Moore, Hunter B. Moore, Matthew D. Neal, Scott Thomas, Rashid Z Khan, Laura Gillespie, Charles Florance, Josh Korzan, Fletcher R. Preuss, Dan Mason, Tarek Saleh, Mathew Marsee, Stefani Vande Lune, Qamarnisa Ayoub, D Friès, Mark Walsh,

Muscle and Compartmental Disorders

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.