Évolution de la stratégie transfusionnelle en temps de guerre

Uncontrolled post-traumatic bleeding remains the leading cause of preventable deaths on the battlefield. The initial coagulation resuscitation forms an essential component of the “Damage Control Resuscitation”. Its aim is to rapidly and aggressively treat the bleeding and the coagulopathy. In this austere environment, there are many logistical constraints, while the needs are higher than in civilian trauma. Tranexamic acid should be administered as early as possible on the battlefield, as an early administration significantly reduces the risk of death. A prehospital blood product transfusion during evacuation is performed for the most severely injured patients. For this purpose, the French lyophilised plasma, manufactured by the French Military Blood Institute, compatible with any blood type and secure, is particularly interesting. Most armies have red blood cell concentrates and plasma on the field, but only a few have platelets. A high plasma-to-red cell ratio (1:2 or 1:1) is associated with improved survival in combat casualties. Fresh whole blood transfusion, collected and qualified locally, must be exceptional and justified by the limited resources and the lack of platelets. The estimated residual infectious risk is much lower than the risk of death from massive bleeding. The “point-of-care” test can be used successfully in an austere environment but clinical data prevail as long as the surgical haemostasis has not been realised.