Blood Just In Time, Not Just In Case
Blood Far Forward
In combat scenarios, timely access to blood can mean the difference between life and death for casualties suffering from haemorrhage. There is both clinical and organisational recognition that providing blood at or near the point of wounding offers significant advantages. This concept, known as ‘blood far forward’, is crucial in emergency medical care on the battlefield.
Introducing CryoShield Red
CryoShield Red is designed to freeze blood without significant erythrocyte lysis caused by intracellular ice crystals.
Quick Thawing and Washing: Blood can be thawed and washed rapidly compared to current systems.
Minimal Cell Loss: The system is 95% effective in preventing cell loss through lysis.
Normal Oxygen Transport: The thawed blood retains its ability to transport oxygen effectively.
These features make CryoShield Red exceptionally suitable for combat casualty situations, where traditional blood storage and delivery present logistical challenges and potential wastage. CryoShield Red ensures that life-saving blood is available where and when it is needed the most, maximizing the chances of survival and recovery for wounded soldiers.
Recognised Importance of Haemorrhage
There is a clear recognition that haemorrhage is the major cause of death in trauma, including in combat. Furthermore, it is recognised that catastrophic haemorrhage is the leading preventable cause of death in the combat casualty.
Measures to Treat Haemorrhage
There have been significant advances over the past two decades, addressing the problem of haemorrhage in combat casualty care (CCC). These measures have included a redefining of priorities of care from Airway Breathing and Circulation (ABC) to <C>ABC, where C is catastrophic haemorrhage.
Over the past 15-uears, measures have been introduced aimed at staunching external (compressible) haemorrhage in limbs, with the use of tourniquets, haemostatic agents on dressings and the systemic treatment with activated clotting factors (rFVIIa) and Tranexamic acid.
Attention has also been paid to the role of early resuscitation with blood products. The concept of Blood Far Forward has grown in importance.
These measures did not occur in isolation; there were important changes to the philosophy of delivery of care to include expertise far forward and rapid casualty retrieval (the Medical Emergency Response Teams, MERT) and the prioritisation of Damage Control Resuscitation (DCR), practicing that in the far forward situation (Remote DCR, RDCR) and recognising that some casualties need to go straight to surgery on arrival in the medical facility (“turn right”) for their resuscitation to be optimised, particularly when there is non-compressible haemorrhage.
Resuscitation is not simply about replacing the lost blood and staunching haemorrhage; rather the approach has to take account of haemorrhage mediated end-organ hypoxia, resulting in the “lethal triad” of trauma: hypothermia, coagulopathy, acidosis.
Blood and Blood Product Transfusion
Blood and blood products, when administered early, play a critical role in addressing the problem of haemorrhage. In Afghanistan, the Medical Emergency Response Team (MERT) typically carried 2 units of red cells and 2 units of fresh frozen plasma (FFP). These were often administered early in the resuscitation of casualties with haemorrhage, in a 1:1 ratio, frequently through intra-osseous routes.
Advances in civilian medical practice have also recognized the value of component therapy (CT), which utilizes red blood cells (RBC), FFP, and platelets. Numerous publications, including research from the Defence Science and Technology Laboratory (DSTL), have demonstrated the value of this approach in resuscitation and improving patient outcomes.
On average, 4500 to 5000 units of blood are used each day in the NHS, with about a third of this usage dedicated to surgery and the management of haemorrhage (including trauma and childbirth).
Reference
Eastridge BJ, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5).
Between October 2001 and June 2011, during US involvement in conflict in Iraq, 4,596 battlefield fatalities were reviewed and analyzed. Of all injury mortalities, 87.3% occurred in the pre-Medical Treatment Facility (pre-MTF) environment. Of these pre-MTF deaths, 75.7% (n = 3,040) were classified as non-survivable, and 24.3% (n = 976) were deemed potentially survivable (PS). The primary cause of PS acute mortality was haemorrhage (90.9%), with the sites of lethal haemorrhage being truncal (67.3%), junctional (19.2%), and peripheral-extremity (13.5%).
It has been recognized that to significantly improve the outcomes of combat casualties with potentially survivable injuries, strategies must be developed to mitigate haemorrhage, optimize airway management, and reduce the time interval between the battlefield point of injury and surgical intervention.
Data Panel
Our rapid thaw and wash out solution ensures timely blood availability, enabling organisations, such as the military or blood transfusion services, to manage effectively surges in demand without the resupply problems and potential wastage inherent in cool storing blood (2-8 degrees) “just in case”.
MoD Defence Medical Services
Holding blood in a frozen state, using the CryoShield Red process, allows for rapid supply of blood when needed in a sorward surgical facility, for a surge, or anticipated surge, in casualties – blood available just in time.
Applications
NHS
Blood for remote areas, even in the UK, can present a challenge. About 1/3 of the NHS blood supply is used for the treatment of bleeding in surgery, trauma or childbirth. Holding blood “just in case” has the potential for wastage or shortage. CryoShield Red offers a solution.
Emergency and Disaster Planning
The shelf life of blood, if cool stored at 2-8 degrees, presents a logistical problem when storing large quantities for unlikely but potentially devastating emergencies. Using CryoShield Red allows that blood to be frozen and stored for very long periods yet making it available as the thawed and transfusable product rapidly if needed ‘just in time’.
CryoShield Red Team
Dr Gavin Bowyer
MA MChir FRCSOrth
Gavin Bowyer has been a trauma and orthopaedic surgeon for more than 3 decades. He spent almost 20-years in the Army, including a trauma fellowship in the USA (Shock Trauma Centre, Baltimore) and several operational tours leading a field surgical team. He also undertook research into small fragment wounds when working at what is now DSTL Porton Down. His research and its clinical application led to a change in the way that small fragment wounds are managed and also led to him being awarded a Hunterian Professorship at the Royal College of Surgeons.
Gavin came on board with CryoLogyx in mid-2021. Initially sceptical about freezing blood, he soon recognised the potential of CryoShield and has been a strong advocate for this, leading to Defence and Security Accelerator (DASA) grants and helping to define the clinical applications for this in both military and civilian blood transfusion.
Dr Alex Murray
Research Scientist
Alex has had an interest in cryopreservation and formulation since 2018, when he developed a formulation to permeabilize fruit fly larvae to cryoprotectants. He completed his PhD in 2023, which focused on cryoprotectant formulation for red blood cells and lymphocytes. During this time he used his knowledge of cryopreservation to create an early version of the Cryoshield Red formulation, finding the right combination of cryoprotectants that could be rapidly removed post thaw, while still providing full cryoprotection. Alex joined CryoLogyx shortly after, working on the research and development of Cryoshield Red.
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