Transfusion et hémorragie:12 reco canadiennes

Best practices on blood and blood products for a prehospital hemorrhage protocol: consensus from the 2025 Canadian prehospital transfusion summit
Peddle M et Al.Scand J Trauma Resusc Emerg Med. 2026 Jun 3;34(Suppl 1):100.

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Un regard un peu différent sur l'utilité du fibrinogène et du PPSB/Kanokad

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Background: Blood transfusion is increasingly recognized as a critical component of prehospital resuscitation. However, Canada's vast geography, environmental extremes, and regional variation in health systems present unique challenges to standardized implementation of prehospital hemorrhage protocols (PHPs). The 2025 Canadian Prehospital Transfusion Summit (CPTS), convened by the Canadian Prehospital and Transport Transfusion (CAN-PATT) network, sought to develop consensus-driven best practices for prehospital transfusion strategies across diverse transport environments.

Methods: A structured roundtable consensus process was held at CPTS 2025, bringing together over 50 subject matter experts from eight provinces, six different services/systems and a variety of operational roles to discuss the past, present and future direction of out-of-hospital blood transfusion in Canada. Key domains included: activation criteria, prioritization of blood components and adjuncts, product logistics, and rural/remote applicability. Recommendations were synthesized through iterative discussion, evidence review, and thematic analysis. Each recommendation was then voted upon until consensus was reached through all participants.

Results: Consensus was reached on core components of a national PHP. Red blood cells and tranexamic acid were identified as foundational therapies. Freeze-dried plasma and whole blood offer logistical and clinical advantages, particularly in rural and remote areas, while fibrinogen concentrate and prothrombin complex concentrate are valuable adjuncts when plasma is unavailable. Calcium supplementation and active hypothermia prevention were emphasized as essential. Barriers to implementation included short product shelf-life, storage infrastructure, and regulatory constraints. The group recommended development of a standardized Canadian prehospital transfusion dataset and national data registry.

Conclusions: The panel produced 12 consensus statements based on the available evidence and expert opinion including activation criteria, prioritization of blood products and adjuncts, product logistics, and rural/remote applicability. These consensus statements establish the basis for safe and effective PHP practices in Canada.

Réchauffement cutané actif : Rappel et Prudence

Surface Temperatures of Self-Warming Chemical Blankets Exceed Established Safety Thresholds: A Standardized Bench-Testing Study
Ralph N et Al. Mil Med. 2026 Sep 17:usag430. doi: 10.1093/milmed/usag430.

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Le sujet n'est pas nouveau, loin de là. Cette étude confirme que ce type d'équipement n'est as la panacée et que son utilisation doit être faite en connaissance de ses limites: ils ne traitent pas une hypothermie et ne doivent jamais être appliqués directement sur la peau. 

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Introduction: Self-warming chemical blankets are widely deployed in military, prehospital, and hospital settings as a power-independent warming solution. Despite widespread use, no harmonized safety standard governing surface temperature limits for this device class is known to exist, and independent bench-testing data are sparse. This study aimed to characterize the thermal performance and safety profiles of commercially available self-warming chemical blankets and evaluate their suitability for use in military, prehospital, and perioperative contexts.

Materials and methods: Four self-warming chemical blanket devices were subjected to standardized laboratory bench testing following the IEC 60601-2-35:2021 framework as an analogical reference standard. Twelve-channel K-type thermocouple arrays and infrared thermography recorded surface temperature distribution over time. Key outcomes included time to 40°C, maximum recorded surface temperature, surface temperature uniformity, and sustained high-temperature exposure duration.

Results: The Hypothermia Prevention and Management Kit (HPMK) Full Body and HPMK-I Full Body Self-Heating Blankets reached maximum recorded temperatures of 69.1°C and 69.0°C, respectively, and the Ready-Heat Full Body Self-Heating Blanket reached 68.7°C, all substantially and persistently exceeding established burn thresholds for more than 12 hours.

 

The Mölnlycke Barrier EasyWarm required over 81 minutes to reach peak temperature, did not achieve 40°C within clinically relevant timeframes, and also exceeded burn thresholds under prolonged contact. No device demonstrated simultaneous rapid attainment of therapeutic temperature and maintenance of safe surface temperatures.

Conclusions: Commercially available self-warming chemical blankets exhibit a dual failure: they are too slow to provide therapeutic warming within the acute treatment window and generate surface temperatures consistent with serious burn risk under prolonged contact, particularly in patients with impaired peripheral circulation or reduced consciousness. The absence of a dedicated safety standard for this device class means that devices generating temperatures far above recognized burn thresholds are fully compliant with current regulatory requirements. The evidence base supporting clinical use of these devices is thin, and these findings are corroborated by burns reported to national device-safety databases. Urgent development of fit-for-purpose safety and performance standards is warranted, alongside review of the guideline endorsement and procurement that sustain the use of these devices.