LAUSR

This is an analysis of blood utilization used within the US Central Command area of responsibility over the last decade just prior to the end of combat operations in Afghanistan. It demonstrates how blood utilization has evolved and weaknesses in the system. BACKGROUND Military involvement in Afghanistan ended in 2021, and while low-intensity troop engagements continue globally, casualty numbers are dwindling. To understand the clinical and operational connections between blood utilization and clinical paradigm shifts in resuscitation strategies, a review of blood product utilization and the changes in the last decade was conducted within the US Central Command area of responsibility. The intent of this review was to assess patterns of blood use during the last decade of the United States' involvement in the most recent major conflicts to potentially inform future blood requirements. METHODS Blood product and types transfused between January 1, 2011, and December 31, 2020, were acquired from the Medical Situational Awareness in Theater blood reports. All reported blood usage data in the US Central Command area of responsibility were queried. RESULTS Packed red blood cells and fresh frozen plasma (FFP) usage showed no statistically significant change over time (τb = 0.24, p = 0.3252; τb = −0.47, p = 0.0603). Fresh and stored whole blood (SWB) use increased overtime (τb = 0.69, p = 0.0056; τb = 0.83, p = 0.0015). A strong inverse relationship was found between SWB and FFP usage (r = −0.68, p = 0.0309) and liquid plasma and FFP usage (r = −0.65, p = 0.0407) over time. CONCLUSION Whole blood usage increased significantly over time with a preference for SWB. Component therapy is anticipated to remain a critical element of resuscitation in the event of large-scale combat operations secondary to supply chain and longer storage times. LEVEL OF EVIDENCE Therapeutic/care management; Level III.