Blood products in High Arctic military operations: Logistics, cold‐chain performance, and post‐deployment assessment

BACKGROUND: Early blood transfusion in hemorrhagic patients saves lives. This study seeks to demonstrate operational capability to deploy blood to the High Arctic, while evaluating performance of blood transport containers and transfusion suitability and functional integrity of blood products post-deployment. STUDY DESIGN: Blood products (whole blood [5 units], packed red blood cells [pRBCs; 5 units], dried plasma [2 units], fibrinogen concentrate [2 units]) were deployed by the Canadian Armed Forces to Resolute Bay and Eureka, NU using passive (Crēdo 4 Nested; Golden Hour Mobile [GH-Mobile]) and active (RINIX) blood transport systems, with continuous temperature monitoring. Post-deployment testing assessed hemolysis, hematologic indices, coagulation function, biochemical parameters, and citrate stability in blood collection kits. RESULTS: A continuous cold-chain was successfully maintained throughout the 3-week exercise, deploying blood from southern Canada to the High Arctic. RINIX served as the primary operational refrigerated storage at Role 1 facilities, while the Crēdo 4 Nested provided superior thermal protection during movement phases. Extreme cold conditions reduced GH-Mobile performance to ~2-3 h, limiting its utility for rapid field blood delivery. Phase-change material required modified conditioning at 4°C and ≥30 min equilibration to mitigate inadvertent freezing. Whole blood largely maintained transfusion suitability with preserved cell integrity and hemostatic function, while pRBCs preserved cell integrity. Lyophilized products retained functional integrity despite sub-zero and freeze-thaw exposure, while citrate solution remained functional after thermal excursions. CONCLUSION: Deployment of blood to the High Arctic is feasible; however, logistical complexities remain the principal barrier in sustaining transfusion capability in this austere environment.