March 17, 2021

The Deployed Hemostatic Emergency Resuscitation of Traumatic Exsanguinating Shock (Deployed HEROES) Study

Researcher to Watch:

COL Jennifer M. Gurney, MD

 

An estimated 90% of potentially survivable combat deaths are due to uncontrolled blood loss, or hemorrhage. In the bleeding patient, the priority is to stop the hemorrhage as quickly as possible, maintain oxygen delivery, and restore normal physiology – and all of this combined is called resuscitation. When resuscitation does not occur fast enough, or in the case of significant hemorrhage, coagulopathy and acidosis develop which exacerbate bleeding. Appropriate early blood transfusion can mitigate shock, acidosis, and coagulopathy resulting in decreased death from hemorrhage. The wars in Iraq and Afghanistan have underscored the importance of early and appropriate transfusion.

Geneva researcher COL Jennifer M. Gurney, MD is working at the U.S. Army Institute of Surgical Research (USAISR) on a study titled, “The Deployed Hemostatic Emergency Resuscitation of Traumatic Exsanguinating Shock (Deployed HEROES) Study” that was funded for $1.1 million dollars under a Cooperative Agreement in September 2020 from the U.S. Army Medical Research Acquisition Activity (USAMRAA). COL (Dr.) Gurney is a trauma surgeon and Chief of the Defense Committees on Trauma at the Joint Trauma System.

COL (Dr.) Gurney’s research team has demonstrated the importance of “when to transfuse,” and now the team aims to determine the importance of “what to transfuse.” Strategies for transfusion of blood products may have significance in hemorrhage control. To support “what to transfuse” in the fielding of blood products, specific guidelines are needed for in-theater blood use and the comparative efficacy of a walking blood bank versus shipped and stored low titer O whole blood (LTOWB). By providing evidence supporting the best resuscitation guidance, the goal of this study is to improve resuscitation strategies and decrease preventable death from hemorrhage.

“Combat casualty care research and evidence-based decision support is the driver of improved outcome for combat casualties… and all trauma patients. It is of paramount importance that we continuously reevaluate our processes and improve battlefield care through performance improvement and directed research,“ said COL (Dr.) Gurney.

The study examines transfusion strategies over the last 18 years using 14,000 patient records from the Department of Defense Trauma Registry, Theater Medical Data Store, and Armed Services Blood Program database. Records from patients injured from 2001-2019 in the U.S. Central Command operational environment, including both military and non-military patients, who received a blood product will also be included. The military has led the way with transfusion strategies. LTOWB has been used since 2016 and FWB from walking blood banks has been implemented throughout the entire conflict. Understanding outcomes related to different transfusions will help inform future trauma care and save lives on the battlefield.

 

Disclaimer: The views expressed do not reflect the official policy of the Army, the Department of Defense, or the U.S. Government.