Comparing the effects of various fluid resuscitative strategies on Glycocalyx damage in a canine hemorrhage model.

Hemorrhagic shock and subsequent resuscitation can cause significant dysregulation of critical systems, including the vascular endothelium. Following hemorrhage, the endothelial lining (glycocalyx) can shed, causing release of glycocalyx components, endothelial activation, and systemic inflammation. A canine model of hemorrhagic shock was used to evaluate five resuscitation fluids, including Lactated Ringers+Hetastarch, Whole Blood (WB), Fresh Frozen Plasma+packed Red Blood Cells (FFP+pRBC), and two hemoglobin-based oxygen carrier (HBOC) fluids, for their impact on glycocalyx shedding.

Comparison of shelf-stable and conventional resuscitation products in a canine model of hemorrhagic shock.

Background: Treatment of severe hemorrhagic shock typically involves hemostatic resuscitation with blood products. However, logistical constraints often hamper the wide distribution of commonly used blood products like whole blood. Shelf-stable blood products and blood substitutes are poised to be able to effectively resuscitate individuals in hemorrhagic shock when more conventional blood products are not readily available.

A scoping review of two decades of pediatric humanitarian care during wartime.

Abstract: Humanitarian care is a vital component of the wartime mission. Children comprise a significant proportion of casualties injured by explosives and penetrating weapons. Children face a variety of unique injury patterns in the combat setting as high-powered firearms and explosives are rarely seen in the civilian setting.

Battlefield pain summit 2022: Expert consensus statements.

Background: Battlefield pain occurs in combat casualties who experience multiple severe injuries. The nature of battlefield scenarios requires a distinct approach to battlefield pain research. A battlefield pain summit was thus convened to identify shortcomings in the current understanding of battlefield pain management, review the current state of battlefield pain research, and shape the direction of future research.

Data-driven readiness: A preliminary report on cataloging best practices in military civilian partnerships.

Background: Between conflicts, many of the combat casualty care lessons learned are lost as the nation shifts priorities and providers leave the military. Solutions are needed to bridge the knowledge gap created by interwar periods. One of the foremost solutions is partnerships between civilian trauma centers and the military health system.

Determining resuscitation outcomes in combat casualties: Design of the Deployed Hemostatic Emergency Resuscitation of Traumatic Exsanguinating Shock (Deployed HEROES) study.

Background: During the course of the recent conflicts, the recommendations for resuscitation practices have evolved, but there has been no comprehensive comparative effectiveness study of these resuscitation strategies. The objective of this study was to describe the development and study design of the Deployed Hemostatic Emergency Resuscitation of Traumatic Exsanguinating Shock (Deployed HEROES) study-the first comprehensive analysis of military resuscitation practices in the deployed environment from October 2001 to October 2019.

Methods: This retrospective cohort study uses the Department of Defense Trauma Registry, Armed Services Blood Program database, and Military Trauma Mortality Review, while abstractors will use Theater Medical Data Store and Web Interface Patient Records to collect transfusion timing data.

A mixed methods end-user assessment to determine the ideal supraglottic airway device for inclusion into the medic's aid bag.

Background: Many advancements in supraglottic airway technology have occurred since the start of the Global War on Terrorism. While the Tactical Combat Casualty Care guidelines previously recommend the i-gel device, this is based on little data and minimal end-user input.

Objective: We sought to use a mixed methods approach to investigate the properties of an ideal device for inclusion into the medic's aid bag.

Advanced medical monitoring for the battlefield: A review on clinical applicability of compensatory reserve measurements for early and accurate hemorrhage detection.

Hemorrhagic shock remains the leading cause of mortality in civilian trauma and battlefield settings. The ability of combat medics and other military medical personnel to obtain early identification and assessment of a bleeding casualty is hampered by the use of standard vital signs that fail to provide early predictive indicators of the onset of shock because of compensatory mechanisms. Over the past decade, the emergence and application of new technologies that incorporate the use of artificial intelligence have revealed that continuous, real-time arterial waveform analysis (AWFA) reflects the recruitment of such compensatory mechanism.

Analysis of the Effects of COVID-19 Mask Mandates on Hospital Resource Consumption and Mortality at the County Level.

Objectives: Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas.

Synthetic blood and blood products for combat casualty care and beyond.

Synthetic biology adopts an engineering design approach to create innovative treatments that are reliable, scalable, and customizable to individual patients. Interest in substitutes for allogenic blood components, primarily red blood cells and platelets, increased in the 1980s because of concerns over infectious disease transmission. However, only now, with emerging synthetic approaches, are such substitutes showing genuine promise.

Extremity trauma exacerbates acute kidney injury following prolonged hemorrhagic hypotension.

Background: The incidence of and mortality due to acute kidney injury is high in patients with traumatic shock. However, it is unclear how hemorrhage and trauma synergistically affect renal function, especially when timely volume resuscitation is not available.

Method: We hypothesized that trauma impairs renal tolerance to prolonged hemorrhagic hypotension.

Saving the brain after mild-to-moderate traumatic injury: A report on new insights of the physiology underlying adequate maintenance of cerebral perfusion.

Abstract: Traumatic brain injury (TBI) is associated with increased morbidity and mortality in civilian trauma and battlefield settings. It has been classified across a continuum of dysfunctions, with as much as 80% to 90% of cases diagnosed as mild to moderate in combat casualties. In this report, a framework is presented that focuses on the potential benefits for acute noninvasive treatment of reduced cerebral perfusion associated with mild TBI by harnessing the natural transfer of negative intrathoracic pressure during inspiration.

Efficacy of resuscitation with fibrinogen concentrate and platelets in traumatic hemorrhage swine model.

Background: This study compared the resuscitation effects of platelets and fibrinogen concentrate (FC) on coagulation and hemodynamics in pigs with traumatic hemorrhage and reduced platelet counts.

Methods: Thirty pigs (40 ± 3 kg) were anesthetized and catheterized with an apheresis catheter to remove platelets using the Haemonetics 9000 (Haemonetics, Braintree, MA). Afterward, a femur fracture was induced, followed by hemorrhage of 35% the estimated blood volume.

Anatomic injury patterns in combat casualties treated by forward surgical teams.

Background: Role 2 forward surgical teams provide damage-control resuscitation and surgery for life- and limb-threatening injuries. These teams have limited resources and personnel, so understanding the anatomic injury patterns seen by these teams is vital for providing adequate training and preparation prior to deployment. The objective of this study was to describe the spectrum of injuries treated at Role 2 facilities in Afghanistan.

Predictors of hemodynamic decompensation in progressive hypovolemia: Compensatory reserve versus heart rate variability.

Background: Hemorrhage remains the leading cause of death following traumatic injury in both civilian and military settings. Heart rate variability (HRV) and heart rate complexity (HRC) have been proposed as potential "new vital signs" for monitoring trauma patients; however, the added benefit of HRV or HRC for decision support remains unclear. Another new paradigm, the compensatory reserve measurement (CRM), represents the integration of all cardiopulmonary mechanisms responsible for compensation during relative blood loss and was developed to identify current physiologic status by estimating the progression toward hemodynamic decompensation.

Indices of muscle and liver dysfunction after surviving hemorrhage and prolonged hypotension.

Background: This study determined the long-term effects of prolonged hypotension (PH) on liver, muscle, and kidney dysfunction. The hypothesis was that longer duration of PH after hemorrhage will result in greater organ dysfunction.

Methods: Baboons were sedated and hemorrhaged (30% blood volume).

Noninvasive diagnostics for extremity compartment syndrome following traumatic injury: A state-of-the-art review.

Acute compartment syndrome (ACS) is a serious medical condition that can occur following traumatic injury to an extremity. If left undiagnosed, ACS can eventuate in amputation of the limb or even death. Because of this, fasciotomy to release the pressure within the muscle and restore tissue perfusion is often performed upon suspicion of ACS, as the sequelae to fasciotomy are less severe than those associated with not performing the fasciotomy.

Prehospital Airway Management in Iraq and Afghanistan: A Descriptive Analysis.

Objectives: Airway failures are the second leading cause of potentially preventable death on the battlefield. Improvements in airway management depend on identifying current challenges. We sought to build on previously reported data on prehospital, combat airway management.

A US military Role 2 forward surgical team database study of combat mortality in Afghanistan.

Background: Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care.

Factors associated with trauma patients' length of stay at Role 2 facilities in Afghanistan, October 2009 to September 2014.

Background: Understanding patients' length of stay at far-forward Role 2 surgical units may help to determine support needs, stabilization requirements, predeployment training, and necessity of increased care capability before or during transport to a higher level of care. The objectives of this study were to (1) evaluate the amount of time patients spent at Role 2 and (2) determine the factors associated with trauma patients' length of stay at Role 2.

Methods: We conducted a secondary data analysis of the Joint Trauma System Role 2 Database.

Reexamination of a Battlefield Trauma Golden Hour Policy.

Background: Most combat casualties who die, do so in the prehospital setting. Efforts directed toward alleviating prehospital combat trauma death, known as killed in action (KIA) mortality, have the greatest opportunity for eliminating preventable death.

Methods: Four thousand five hundred forty-two military casualties injured in Afghanistan from September 11, 2001, to March 31, 2014, were included in this retrospective analysis to evaluate proposed explanations for observed KIA reduction after a mandate by Secretary of Defense Robert M.

Platelet and coagulation function before and after burn and smoke inhalation injury in sheep.

Background: Smoke inhalation and burn injury remain a major source of morbidity and mortality. There is known dysregulation of hemostasis in burn patients, but either hypercoagulation or hypocoagulation states are reported. Sheep are an established animal model for studying burn pathology and provide robust data on hemostatic function at baseline and after injury.

Do vented chest seals differ in efficacy? An experimental evaluation using a swine hemopneumothorax model.

Objective: Airways compromise was the second leading cause of potentially preventable death among combat casualties. We investigated the ability of five Food and Drug Administration-approved nonocclusive chest seals (CSs) to seal a bleeding chest wound and prevent tension hemopneumothorax (HPTX) in a swine model.

Methods: Following instrumentation, an open chest wound was created in the left thorax of spontaneously air-breathing anesthetized pigs (n = 26; 43 kg).

Evaluation of adenosine, lidocaine, and magnesium for enhancement of platelet function during storage.

Background: The combination of adenosine, lidocaine, and magnesium (Mg2+) (ALM) has demonstrated cardioprotective and resuscitative properties in models of cardiac arrest and hemorrhagic shock that are linked to reduction of metabolic demand. Platelets play a key role in resuscitation strategies for ATC but suffer from loss of function following storage in part owing to mitochondrial exhaustion. This study evaluates whether ALM also demonstrates protective properties in stored platelet preparations.

Volumetric control of whole blood collection in austere environments.

Introduction: Fresh whole blood transfusions are a powerful tool in prehospital care; however, the lack of equipment such as a scale in field situations frequently leads to collections being under- or overfilled, leading to complications for both patient and physician. This study describes two methods for simple, rapid control of collection bag volume: (1) a length of material to constrict the bag, and (2) folding/clamping the bag.

Method: Whole blood collection bags were allowed to fill with saline via gravity.