Accuracy of 6.5" Beaded Cable Tie, 10" Paracord, and Operator Gestalt in Prehospital Whole Blood Collection Techniques in Filling Donor Blood Bags to Target Volume

BACKGROUND: Whole blood reduces mortality more effectively than blood component therapy in treating trauma. When cold-stored low-titer Type O whole blood (CS-LTOWB) is not available in austere environments, a walking blood bank (WBB) strategy is employed, with blood drawn from a local, pre-screened donor. Proper blood bag volume is essential for avoiding citrate-related complications; however, the optimal method for determining the correct blood bag volume is unclear. METHODS: Novices (n=65) and experts (n=10) at the 1st Marine Division each filled blood bags with the goal of hitting the target volume (450mL ±10%) using the 6.5" beaded cable tie (BC), 10" paracord (PC), and operator gestalt (OG) techniques. Filled bags were weighed on a digital scale. Correct fills, underfills, and overfills were assessed using nonparametric statistics at P=.05. Subjective assessments were also collected. RESULTS: For novices, OG achieved the highest rate of correct fills (69%), significantly outperforming BC (37%, P=.001) and PC (52%, P=.05). In experts, PC had the highest rate of correct fills (80%), though not significantly different from OG (70%, P=.59) or BC (50%, P=.08). OG was rated highest and was preferred by both groups. BC performed worst in objective and subjective measures for both groups. CONCLUSION: BC performed poorly on all assessments and should be avoided. OG was generally superior to BC and PC, but was still suboptimal, with ~30% incorrect fills study-wide. Present findings demonstrate the need for better methods for determining donor blood bag fill volume to preserve the life of the wounded warfighter in WBB scenarios.