Advanced Resuscitative Care in Tactical Combat Casualty Care: TCCC Guidelines Change 18-01:14 October 2018

Area of Science:

• Combat medicine
• Trauma surgery
• Emergency medical services

Background:

• Tactical Combat Casualty Care (TCCC) has reduced prehospital deaths from extremity hemorrhage, airway obstruction, and tension pneumothorax.
• Noncompressible torso hemorrhage (NCTH) remains a leading cause of preventable battlefield mortality, often resulting in rapid death.

Purpose of the Study:

• To introduce Advanced Resuscitative Care (ARC) as a strategy to address NCTH.
• To highlight the potential of whole blood transfusion and Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in improving survival for severe torso hemorrhage.

Main Methods:

• Utilizing whole blood for massive transfusion in casualties with thoracic and/or abdominopelvic hemorrhage.
• Implementing Zone 1 REBOA for temporary hemorrhage control in the abdomen and pelvis, and hemodynamic stabilization.

Main Results:

• ARC interventions have the potential to increase survival in casualties with severe NCTH.
• ARC may enable casualties to survive longer, facilitating transport for surgical intervention.

Conclusions:

• Advanced Resuscitative Care (ARC) combines whole blood transfusion and REBOA to manage battlefield NCTH.
• Widespread implementation requires specialized training and resources, currently limited to specific units.