WarDocs - The Military Medicine Podcast
Health & Fitness:Medicine
How does Military Medicine learn lessons and overcome barriers in trauma resuscitation?
How have transfusion practices on the battlefield evolved?
Tune in and find out!
Intro: WarDocs had the pleasure of discussing the evolution of transfusion medicine on the battlefield with LTC(R) Philip C. Spinella, MD, a Professor in the Departments of Surgery and Critical Care Medicine and Co-director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. We delved into the history of blood transfusion practices during the Vietnam War, the shift from using whole blood to a mixture of red cells and crystalloids, and the lessons learned from Iraq and Afghanistan. We also explored the concept of damage control resuscitation, the transition from component therapy to whole blood therapy, and the barriers faced in developing high-level evidence through randomized controlled trials. Additionally, we touched on life-threatening hemorrhage in pediatric patients, the differences between adult and pediatric populations, and the future of therapy for life-threatening hemorrhage. Don't miss this fascinating episode highlighting the importance of having various tools in the "toolbox" to ensure the best care for patients experiencing life-threatening hemorrhage.
Chapters:
(0:00:00) - Transfusion Medicine on Battlefield
(0:09:12) - The Evolution of Hemostatic Resuscitation
(0:18:24) - Damage Control Resuscitation
(0:28:10) - Trauma Care
(0:37:08) - Precision Transfusion Medicine
Chapter Summaries:
(0:00:00) - Transfusion Medicine on Battlefield (9 Minutes)
In this episode, we explore the evolution of transfusion medicine on the battlefield with LTC(R) Philip C. Spinella, MD, a Professor in the Departments of Surgery and Critical Care Medicine and Co-director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. We discuss how strategies for hemostatic resuscitation have moved from component therapy to whole blood transfusion. Dr. Spinella shares his experiences deploying to Baghdad in 2004 and working with the 31st Combat Support Hospital.
(0:09:12) - The Evolution of Hemostatic Resuscitation (9 Minutes)
We dive into the history of blood transfusion practices during the Vietnam War and the shift from using whole blood to a mixture of red cells and crystalloids. The conversation highlights the lessons learned from Iraq and Afghanistan and the importance of keeping this knowledge alive for future conflicts. The discussion also covers the role of transfusion ratios in improving outcomes, the origin of the one-to-one-to-one ratio, and the use of recombinant activated factor VIIa in trauma resuscitation. Dr. Philip C Spinella shares the fascinating story behind these developments and the importance of considering a bundle of care for optimal patient outcomes.
(0:18:24) - Damage Control Resuscitation (10 Minutes)
We discuss the concept of damage control resuscitation and the transition from component therapy to whole blood therapy with the various barriers that needed to be overcome. Focusing on the importance of safety in transfusion medicine, we explore the challenges in developing high-level evidence through randomized controlled trials and the alternative approach of focused empiricism. We also examine the three main barriers to whole blood use in hemostatic resuscitation: ABO specificity, leukocyte reduction, and cold storage platelets.
(0:28:10) - Trauma Care (9 Minutes)
In this conversation, we examine life-threatening hemorrhages in pediatric patients and the differences between adult and pediatric populations. We discuss an NIH-sponsored prospective observational study that found a higher mortality rate in children with massive bleeding compared to adults. We also explore the types of whole blood, their nuances, and how they differ from component therapy. Additionally, we touch on the role of freeze-dried plasma in transfusion options and the current state of synthetic blood products. Ultimately, we emphasize the importance of having various tools in the "toolbox" to ensure the best care for patients experiencing life-threatening hemorrhage.
(0:37:08) - Precision Transfusion Medicine (9 Minutes)
We delve into the development of a dry artificial whole-blood product and its potential applications for various types of bleeding. This project, funded by DARPA, aims to create custom-made whole blood-like products specific to a patient's coagulopathy. We also discuss the challenges and barriers in conducting clinical trials in transfusion medicine, emphasizing the importance of funding, access to blood products, and the need for precision transfusion medicine. The conversation also touches on the future of therapy for life-threatening hemorrhage, focusing on metabolism-reducing agents to salvage patients in shock.
Episode Keywords:
Transfusion Medicine, Battlefield, Hemostatic Resuscitation, Whole Blood Therapy, Component Therapy, Damage Control Resuscitation, Vietnam War, Iraq and Afghanistan, Trauma Care, Life-Threatening Hemorrhage, Pediatric Patients, Blood Transfusion Practices, ABO Specificity, Leukocyte Reduction, Cold Storage Platelets, Freeze-Dried Plasma, Synthetic Blood Products, Precision Transfusion Medicine, Coagulopathy, Metabolism-Reducing Agents
#wardocs #military #medicine #podcast #TransfusionMedicine #BattlefieldMedicine #HemostaticResuscitation #WholeBloodTherapy #DamageControlResuscitation #PediatricHemorrhage #TransfusionResearch #MilitaryMedicine #BloodTransfusionEvolution #LifeSavingMedicine
Honoring the Legacy
and Preserving the History of Military Medicine
The WarDocs Mission is to improve military and civilian healthcare and foster patriotism by honoring the legacy, preserving the oral history, and showcasing military medicine career opportunities, experiences, and achievements.
Find out more and join Team WarDocs at https://www.wardocspodcast.com/
Check our list of previous guest episodes at https://www.wardocspodcast.com/episodes
Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm
WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in military medicine. A tax receipt will be sent to you.
WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.
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MG(R) George Weightman, MD- Commander, Command Surgeon- Optimizing Medical Support to Combat Units Across the Globe
Lt Gen (Ret) Bruce Green, MD- 20th Air Force Surgeon General Shapes Military Medicine using Crises Leadership Experience Gained in every Region of the World
Command Sergeant Major Diamond D. Hough- US Army Medicine’s Senior Soldier Medic Leverages Battlefield Experience to Influence the Next Generation of Combat Medics.
COL David R. King, MD, FACS- Trauma Surgeon Responds to the Boston Marathon Bombing and Provides and Innovates Surgical Critical Care for Special Operations and Civilian Trauma Patients.
Major General (RET) Gale S. Pollock: CRNA, First Female and First Nonphysician Army Surgeon General and 22nd Chief of the Army Nurse Corps
BG (R) Norvell “Van” Coots, MD Military Medicine Impacts in Eastern Europe and the Middle East; a Motivational Story of Perseverance, Ambition, and a Never Quit Attitude
COL(R) Kent E. Kester, MD- Important Impacts of Translational Research Medicine in Military and Global Healthcare
(Pt. 2) COL(R) John B. Holcomb, MD, FACS- Innovations in Hemorrhage Control and Transfusion Paradigms Redefining Trauma Combat Casualty Care Guidelines (2 of 2)
(Pt. 1) COL(R) John B. Holcomb, MD, FACS- Special Operations Surgeon uses Lessons Learned in Somalia to Revolutionize Combat Casualty Care in the Global War on Terrorism (1 of 2)
WarDocs-The Military Medicine Podcast- What Are We For? Our Origin Story and Mission
LTG(R) Eric B. Schoomaker, MD, PhD, FACP– Adapting to the Challenges of a Constantly Changing Strategic Landscape to Shape and Enhance Military Combat Care (Part 2 of 2)
LTG(R) Eric B. Schoomaker, MD, PhD, FACP – Excellence in Academic Medicine and Strategic Military Medical Leadership (Part 1 of 2)
COL (Ret.) Russ Kotwal, MD, MPH – Studying the Chaos of Battlefield Injuries in a Standardized Manner to Advance Battlefield Trauma Care (Part 2 of 2)
COL (Ret.) Russ Kotwal, MD, MPH – Ranger Battalion and Regimental Medical Care in Two Combat Jumps and 12 Operational Deployments (Part 1 of 2)
COL(R) Edward B. Lucci, M.D.- Disaster Preparedness and CBRN Defense Expert- Responses to 9/11, Anthrax, Ricin and More. Lessons Learned and the Way Forward.
Brigadier General Shan Bagby DMD, MHA – The Importance of developing a Diverse Military Medical Force and Leading through Tough Social Times and an Inside look at Deployed Dental Care (Part 2 of 2)
Brigadier General Shan Bagby DMD, MHA – Battlefield Dental Care, the Role of Dentists in Leading Military Medicine, and the Dual Military and Medical Professional (Part 1 of 2)
COL (R) Robert Adams, MD- Former Navy SEAL Joins Army Medicine- Adventures as the Delta Force Surgeon and Deployments with the 82nd Airborne Division.
RADM Bruce L. Gillingham MD- Pediatric Orthopedic Surgeon, Undersea Medical Officer and Current Surgeon General of the United States Navy.
Lieutenant General (Ret). Mark A. Ediger, MD- From Rural Family Medicine Physician to Flight Surgeon to Air Force Surgeon General
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