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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CSM (Ret.) Rudolfo (Rudy) Delvalle- Combat Ranger Medic to Command Sergeant Major of Walter Reed Army Medical Center: Soldier Medic Leading the Way.
Major General (Ret.) Phillip Volpe, D.O.- Lessons learned from operational medicine experience in Panama, Somalia, Haiti, Korea, Southwest Asia and additional undisclosed locations.
CAPT Christine Sears, M.D.- A Navy Urologist Commanding on the USNS COMFORT and Maintaining Resiliency While Supporting Critical DoD Medical Missions Across the Globe.
BG (Dr.) Mary V. Krueger- Leveraging Character, Training and Experience For Mission Success.
COL Michael Wirt, M.D., Ph.D: Radiology on the Battlefield, Neuroradiology, and Commanding a Level 1 Trauma Center during the COVID pandemic.
COL Will Bimson, D.O.- Combat Cardiologist, Ranger Qualified- Supporting COVID Missions at Home in the USA and Deployments Across the Globe
Dr. Benjamin Starnes- Surgeon Stepping Up to Lead During 9/11 and in Austere Locations Across the Globe
COL(R) Dr. Peter Napolitano- OB/GYN WarDoc- Improving Surgical Patient Safety on the Battlefield and Beyond.
COL(R) Dr. Matthew Hepburn- Military Infection Disease Doc Uniquely Prepared for Operation Warp Speed and Global Pandemic Response.
Lt. Gen. (Ret) Dr. Paul K. Carlton Jr.-Evolution of Critical Care in the Air- Past, Present and Future
Major General (Ret) Dr. Sean L. Murphy- Taking Care of Military Members and their Families from the Far East to Europe to the Pentagon
CAPT (Dr.) Joel Schofer- Deputy Chief of the Navy Medical Corps- Coaching and Mentoring Physicians in Career Development both Online and In-person.
The Journey to Zero Harm- Exploring Quality and Safety in Military Medicine- COL(Ret) Evan Renz, MD, MPH (Part 2 of interview)
COL(Ret) Dr. Evan Renz: From Jumpmaster in the 82nd Airborne Division to Burn/Critical Care Surgeon Extraordinaire.
COL(Ret) Alfonso “Al” Alarcon: Orthopedic Surgery and Military Medical Leadership Around the Globe
Dr. Kevin C. Kiley: 41st Army Surgeon General- Loyalty Down and Choosing the Harder Right- Reflections from a Distinguished Career
Colonel Paul Parker- British Army Surgeon: Drones, Advanced Tourniquets and Blood Products-Future Combat Care Innovations at the Tip of the Spear.
Major General (Dr.) Jeff Clark MC Mission Lessons- Desert Storm to Kosovo to Katrina to Abu Ghraib
Major General Daniel Walrath- Combat Casualty and Inspirational Leader: An Inside look at the Military Medical System from Point of Injury to Recovery
Center for the Intrepid: Lessons Learned from Combat Injuries Have Revolutionized Rehabilitation Care (with Dr. Alderete)
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