TUESDAY, NOVEMBER 2, 2010 casualties from E4


and taking his pulse. Pulse—now taken in the wrist, not the neck, because it’s easier to find — is characterized as “absent,” “weak” or “normal.” On this assessment, lifesaving decisions can be made.


Magical powers The third big blood-related in-


novation involves what happens in the emergency room’s trauma bay and operating room. In the past, patients in shock


were resuscitated with IV fluid, supplemented with red blood cells. Now they’re given whole blood or its equivalent in compo- nents.


Blood is a mixture of about 45


percent cells and 55 percent plas- ma. The latter consists of water, sugars, salts and proteins, includ- ing the “clotting factors” that trig- ger a cascade of reactions ending with the formation of a blood clot. As a trauma patient bleeds, those proteins are consumed. If trans- fusions consist mostly of oxygen- carrying red cells and not enough plasma, bleeding eventually goes out of control. To prevent that, some military


physicians give Factor VIIa, one of the proteins, to people getting 10 or more units of blood in 24 hours. (Such casualties are called “massively transfused” patients.) But there has never been a defini- tive answer on its effectiveness— and there is not likely to be, because randomized controlled studies, the kind most likely to provide an unbiased answer, are not permitted on the battlefield where the patients cannot give consent. What does unequivocally work


is whole blood. Whole blood’s near magical


power to revive trauma patients was recognized on the Western Front in World War I. But when scientists later learned to sepa- rate and store blood components —red cells, plasma and clot-initi- ating particles called platelets — whole-blood transfusions fell out of favor. But in some situations, where


there is no blood bank, using whole blood freshly collected from donors is the only choice. The second battle of Fallujah in Iraq in November 2004 was one of them. Dozens of casualties were massively transfused with whole blood. All survived to be evacuated. “It was just unbelievable that you could have this kind of suc-


cess record. It made us stop and ask how this was happening,” Jenkins recalled. He and other military doctors


later analyzed the experience of soldiers massively transfused at the main military hospital in Baghdad early in the war. The rate of survival was nearly nine times as high for the people who got whole blood (or the equiva- lent of it in components) as for those who got mostly red blood cells and IV fluid. Military doctrinenowis to give


blood in a 1:1:1 ratio of red cells, plasma and platelets. But when surgeons occasionally turn to the “walking blood bank” of regis- tered donors for whole-blood transfusions, they notice an espe- cial benefit. “It seems like you just give this


stuff and it works,” said Rodd Benfield, a Navy surgeon now operating at the hospital at Kan- dahar Air Field. “It’s warm, it’s fresh and it’s blood!” Replacing blood lost with


whole blood or its equivalent in components doesn’t just help re- store clotting. It also reduces the risk of acute respiratory distress syndrome (a condition first rec- ognized during the Vietnam war, whereitwascalledDaNanglung) and multi-organ failure. And the fresher it is, the better. A study done by Holcomb and


others showed that in massively transfused patients, mortality goes up if they get blood more than two weeks old. Old red cells don’t carry oxygen as well as newer ones, and they don’t form as strong clots. Fresher blood also helps reduce infection. At the hospital here, where


grievously wounded patients ar- rive every day, the goal is to give massively transfused patients blood less than 21 days old. On a recent night, surgeons


were operating on someone who had stepped on a mine and lost both legs at the knee. He’d re- ceived 13 units of blood in the appropriate components—about a pint more than an adult typical- ly has in the circulatory system. The anesthesiologist called for


another unit of red cells. When it arrived, a nurse held the bag out for him to inspect. “That blood is going to expire


in four days,” he said. “That’s garbage.” He sent it back and got a newer


one. browndm@washpost.com JOHN AMEND/CORNELL UNIVERSITY


Arubber sack filled with granularmaterial contracts to get a firm grip on a glass.


Fingers and thumbs work


perfectly well for humans, says Eric Brown, a physicist at the University of Chicago. But on a robot they can be clumsy. The fingers slip. They grip too hard and break whatever they’re try- ing to hold.Andsometimes they don’t grasp it at all. Then there are the complexities of manipu- lating 20-odd joints with a com- puter. So Brown and his colleagues


took a different tack. Their ro- botic hand, which they describe in a paper published online by the Proceedings of the National Academy of Sciences, is a thin rubber sack filled with coffee grains or small glass spheres. When this hand comes in con- tact with an object, a small pipe sucks air from the sack, causing it to contract and mold to the object’s shape. The contraction is small — a mere 1 percent change in volume — but that


KLMNO


Scientists get a grip on grasping


Rubber sack on


robotic hand can lift a wide range of objects


BY KRISTENMINOGUE It turns out that opposable


thumbs aren’t critical for get- ting a good grip. Neither are fingers. Scientists have created a robotic hand that can do such things as serve drinks and draw pictures even though it has no digits.


wasenoughto grabmost objects the researchers tested. “It’s very simple to control,” notes Brown. “You don’t have all these joints.” The hand works best on hard,


dry, geometrically complex ob- jects such as screwdrivers and toy jacks. It has more trouble with flat objects such as plastic disksandporous objects such as cotton balls. It also can’t grip anything bigger than half its size: The biggest items the team picked up were one-gallon jugs of water. But the hand’s true strength, according to John Amend, a CornellUniversity en- gineering student and a co-au- thor of the paper, is its versatili- ty. Aside from the limitations noted above, he says, as long as the gripper can grasp about a quarter of the object’s surface, it can pick up just about any shape.


Scientists have been search-


ing for a universal gripper for decades, and the idea of using a deflatable sack instead of fin- gers is notnew, saysYaleUniver- sity physicist Corey O’Hern, who was not part of the study. But this is the first time the idea has been tested and quantified in so much detail. Compared with robotic fingers, he says, “this seems like a much better way to go.” O’Hern suggests solving the porous-object problem by mak- ing the sack stickier. But the problem there, he adds, is that letting go would be hard. Amputees could benefit most


from the technology, says Brown.Having a moldablehand that could hold a fork or swipe a credit card could drastically im- prove the quality of life for the tens of thousands of patients in the United States who have lost an arm.Andwithout the need to manipulate eight fingers and two thumbs, he says, a gripper of this sort would be much easier to operate than many of the prosthetic hands currently on the market.


This article comes from ScienceNOW, the daily online news service of the journal Science, and can be read online at news. sciencemag.org.


EZ EE


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