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08/11/2018

Transport du sang en opex: Loin d'être anodin !

Bringing Packed Red Blood Cells to the Point of Combat Injury: Are We There Yet?

Ünlü et Al.Turk J Haematol. 2018 Aug 3;35(3):185-191.

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Transfuser le plus tôt possible serait un facteur de survie chez le blessé de guerre. Encore faut il disposer de sang et donc d'en transporter. On connaît les règles imposées en métropole. Les conditions de transport en opérations 'ont rien à voir avec celles de métropole. C'est bien ce que décrit cet article qui incite à la prudence. Seules 13% de poches récentes soumises à des vibrations intenses peuvent être transfusées après 06h d'exposition à des vibrations intenses.

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OBJECTIVE:

 

Hemorrhage is the leading cause of injury-related prehospital mortality. We investigated worst-case scenarios and possible requirements of the Turkish military. As we plan to use blood resources during casualty transport, the impact of transport-related mechanical stress on packed red blood cells (PRBCs) was analyzed.

 

 

MATERIALS AND METHODS:

 

The in vitro experiment was performed in the environmental test laboratories of ASELSAN®. Operational vibrations of potential casualty transport mediums such as Sikorsky helicopters, Kirpi® armored vehicles, and the NATO vibration standard MIL-STD-810G software program were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (≤7 days) and 10 units of old (>7 days) PRBCs in a blood cooler box. The vibrations were simulated with a TDS v895 Medium-Force Shaker Device. On-site blood samples were analyzed at 0, 6, and 24 h for biochemical and biomechanical analyses.

 

RESULTS:

The mean (±standard deviation) age of fresh and old PRBCs was 4.9±2.2 and 32.8±11.8 days, respectively. Six-hour mechanical damage of fresh PRBCs was demonstrated by increased erythrocyte fragmentation rates (p=0.015), hemolysis rates (p=0.003), and supernatant potassium levels (p=0.003) and decreased hematocrit levels (p=0.015). Old PRBC hemolysis rates (p=0.015), supernatant potassium levels (p=0.015), and supernatant hemoglobin (p=0.015) were increased and hematocrit levels were decreased (p=0.015) within 6 h.

 

TJH-35-185-g5.jpg

 

Two (13%) units of fresh PRBCs and none of the old PRBCs were eligible for transfusion after 6 h of mechanical stress.

 

CONCLUSION:

When an austere combat environment was simulated for 24 h, fresh and old PRBC hemolysis rates were above the quality criteria. Currently, the technology to overcome this mechanical damage does not seem to exist. In light of the above data, a new national project is being performed.

 

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