Management and outcomes of traumatic colon injury in civilian and military patients.

Divergent injury patterns may indicate the need for differing strategies in combat and civilian trauma patients. This study aims to compare outcomes of colon injury management in these two populations. Parallel retrospective reviews were conducted comparing warfighters (n = 59) injured downrange and subsequently transferred to the United States with civilians (n = 30) treated at a United States Level I trauma center.

A predictive model for mortality in massively transfused trauma patients.

Background: Improvements in trauma systems and resuscitation have increased survival in severely injured patients. Massive transfusion has been increasingly used in the civilian setting. Objective predictors of mortality have not been well described.

High ratios of plasma and platelets to packed red blood cells do not affect mortality in nonmassively transfused patients.

Background: Administration of high transfusion ratios in patients not requiring massive transfusion might be harmful. We aimed to determine the effect of high ratios of fresh frozen plasma (FFP) and platelets (PLT) to packed red blood cells (PRBC) in nonmassively transfused patients.

Methods: Records of 1,788 transfused trauma patients who received <10 units of PRBC in 24 hours at 23 United States Level I trauma centers were reviewed.

Lyophilized plasma with ascorbic acid decreases inflammation in hemorrhagic shock.

Background: Delivery of a high ratio of plasma to packed red blood cells to patients who require massive transfusion is associated with improved survival. Hemorrhagic shock causes increased production of pro-inflammatory cytokines. These are associated with late morbidity and mortality.

Lyophilized plasma reconstituted with ascorbic acid suppresses inflammation and oxidative DNA damage.

Background: Lyophilized plasma (LP) has been shown to be as effective as fresh frozen plasma (FFP) for resuscitation in polytrauma and hemorrhagic shock. LP reconstituted with ascorbic acid is associated with suppression of cytokines when compared with fresh frozen plasma. We aimed to determine the effect of using alternate LP reconstitution acids on physiologic parameters, blood loss, coagulation, oxidative DNA damage, and proinflammatory cytokines in a polytrauma and hemorrhagic shock model.

Advanced hemostatic dressings are not superior to gauze for care under fire scenarios.

Background: Advanced hemostatic dressings perform superior to standard gauze (SG) in animal hemorrhage models but require 2 minutes to 5 minutes application time, which is not feasible on the battlefield.

Methods: Twenty-four swine received a femoral artery injury, 30 seconds uncontrolled hemorrhage and randomization to packing with SG, Combat Gauze (CG), or Celox Gauze (XG) without external pressure. Animals were resuscitated to baseline mean arterial pressures with lactated Ringers and monitored for 120 minutes.

High transfusion ratios are not associated with increased complication rates in patients with severe extremity injuries.

Background: High transfusion ratios of plasma to packed red blood cells (>1:2) have been associated with increased survival and increased complications in patients receiving massive transfusion (MT). We hypothesized that high ratio transfusion would be associated with no survival benefit and increased complications in combat victims with compressible hemorrhage.

Methods: A retrospective analysis of soldiers injured in the current conflict during 5 years (n = 2,105) who received blood was performed on those with isolated extremity (abbreviated injury scale extremity score > or = 3 and abbreviated injury scale score 0-2 in all other regions) injury comparing those who received a MT with those who did not.

Comparison of abdominal damage control surgery in combat versus civilian trauma.

Background: The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents.

Splenectomy leads to a persistent hypercoagulable state after trauma.

Background: It was hypothesized that splenectomy following trauma results in hypercoagulability.

Methods: A prospective, nonrandomized, single-center study was performed to evaluate coagulation parameters in trauma patients with splenic injury.

Results: Patients with splenectomy (n = 30) and nonoperative management (n = 50) were enrolled.

Oncologic outcomes after resection of rectal cancer: Laparoscopic versus open approach.

Background: This study examined outcomes of laparoscopic and open rectal cancer surgery in a community hospital setting.

Methods: A community health care system cancer registry was reviewed retrospectively (2004-2007) for rectal cancer patients undergoing surgical treatment. Primary end points were rates of recurrence and survival.

Effects of ethanol intoxication and gender on blood coagulation.

Background: Ethanol intoxication is a common contributor to traumatic injury. It is unknown whether ethanol consumption contributes to the coagulation differences seen between men and women after trauma. Our aim was to examine the combined effect of ethanol intoxication and gender on coagulation.

Emerging therapies in traumatic hemorrhage control.

Purpose Of Review: Care of the injured patient is a dynamic process. Hemorrhage remains the primary cause of preventable death after trauma. Rapid and effective early care can improve survival and outcomes.

A highly porous silica and chitosan-based hemostatic dressing is superior in controlling hemorrhage in a severe groin injury model in swine.

Background: This study compared the efficacy of 3 hemostatic dressings in a severe groin injury model in swine.

Methods: Twenty-three swine received TraumaStat (OreMedix, Lebanon, OR), Chitoflex (HemCon, Inc., Portland, OR), or standard gauze for hemostasis.

A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study.

Background: In trauma, most hemorrhagic deaths occur within the first 6 hours. This study examined the effect on survival of high ratios of fresh frozen plasma (FFP) and platelets (PLTs) to packed red blood cells (PRBCs) in the first 6 hours.

Methods: Records of 466 massive transfusion trauma patients (>or=10 U of PRBCs in 24 hours) at 16 level 1 trauma centers were reviewed.