Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care

TCCC Guidelines Change 14-01--2 June 2014

Frank K. Butler, John B. Holcomb, Martin Schreiber, Russ S. Kotwal, Donald A. Jenkins, Howard R. Champion, F. Bowling, Andrew P. Cap, Joseph J. Dubose, Warren C. Dorlac, Gina R. Dorlac, Norman E. McSwain, Jeffrey W. Timby, Lorne H. Blackbourne, Zsolt T. Stockinger, Geir Strandenes, Richard B. Weiskopf, Kirby R. Gross, Jeffrey A. Bailey

Research output: Contribution to journalReview article

83 Citations (Scopus)

Abstract

This report reviews the recent literature on fluid resuscitation from hemorrhagic shock and considers the applicability of this evidence for use in resuscitation of combat casualties in the prehospital Tactical Combat Casualty Care (TCCC) environment. A number of changes to the TCCC Guidelines are incorporated: (1) dried plasma (DP) is added as an option when other blood components or whole blood are not available; (2) the wording is clarified to emphasize that Hextend is a less desirable option than whole blood, blood components, or DP and should be used only when these preferred options are not available; (3) the use of blood products in certain Tactical Field Care (TFC) settings where this option might be feasible (ships, mounted patrols) is discussed; (4) 1:1:1 damage control resuscitation (DCR) is preferred to 1:1 DCR when platelets are available as well as plasma and red cells; and (5) the 30-minute wait between increments of resuscitation fluid administered to achieve clinical improvement or target blood pressure (BP) has been eliminated. Also included is an order of precedence for resuscitation fluid options. Maintained as recommendations are an emphasis on hypotensive resuscitation in order to minimize (1) interference with the body's hemostatic response and (2) the risk of complications of overresuscitation. Hextend is retained as the preferred option over crystalloids when blood products are not available because of its smaller volume and the potential for long evacuations in the military setting.

Original languageEnglish (US)
Pages (from-to)13-38
Number of pages26
JournalJournal of special operations medicine : a peer reviewed journal for SOF medical professionals
Volume14
Issue number3
StatePublished - Sep 1 2014
Externally publishedYes

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Hemorrhagic Shock
Resuscitation
Guidelines
Resuscitation Orders
Ships
Hemostatics
Plasma Cells
Blood Platelets
Blood Pressure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care : TCCC Guidelines Change 14-01--2 June 2014. / Butler, Frank K.; Holcomb, John B.; Schreiber, Martin; Kotwal, Russ S.; Jenkins, Donald A.; Champion, Howard R.; Bowling, F.; Cap, Andrew P.; Dubose, Joseph J.; Dorlac, Warren C.; Dorlac, Gina R.; McSwain, Norman E.; Timby, Jeffrey W.; Blackbourne, Lorne H.; Stockinger, Zsolt T.; Strandenes, Geir; Weiskopf, Richard B.; Gross, Kirby R.; Bailey, Jeffrey A.

In: Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, Vol. 14, No. 3, 01.09.2014, p. 13-38.

Research output: Contribution to journalReview article

Butler, FK, Holcomb, JB, Schreiber, M, Kotwal, RS, Jenkins, DA, Champion, HR, Bowling, F, Cap, AP, Dubose, JJ, Dorlac, WC, Dorlac, GR, McSwain, NE, Timby, JW, Blackbourne, LH, Stockinger, ZT, Strandenes, G, Weiskopf, RB, Gross, KR & Bailey, JA 2014, 'Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care: TCCC Guidelines Change 14-01--2 June 2014', Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, vol. 14, no. 3, pp. 13-38.
Butler, Frank K. ; Holcomb, John B. ; Schreiber, Martin ; Kotwal, Russ S. ; Jenkins, Donald A. ; Champion, Howard R. ; Bowling, F. ; Cap, Andrew P. ; Dubose, Joseph J. ; Dorlac, Warren C. ; Dorlac, Gina R. ; McSwain, Norman E. ; Timby, Jeffrey W. ; Blackbourne, Lorne H. ; Stockinger, Zsolt T. ; Strandenes, Geir ; Weiskopf, Richard B. ; Gross, Kirby R. ; Bailey, Jeffrey A. / Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care : TCCC Guidelines Change 14-01--2 June 2014. In: Journal of special operations medicine : a peer reviewed journal for SOF medical professionals. 2014 ; Vol. 14, No. 3. pp. 13-38.
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