Impact of Critical Care Air Transport Team (CCATT) ventilator management on combat mortality

Maddry, Joseph K.; Mora, Alejandra G.; Savell, Shelia C; Perez, Crystal A; Mason, Phillip E.; Aden, James K; Bebarta, Vikhyat S.

doi:10.1097/ta.0000000000001607

Cited by 20 publications

(14 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study demonstrated an association between guideline compliance and decreased ventilator days, intensive care unit days, and 30-day mortality. 34 Studies investigating needle decompression reported 76% failure (potentially correlated with chest wall thickness) with 39% performed in patients without pneumothorax. 33 Overall, studies investigating prehospital thoracostomy reported a 5.2% to 27% increase in complications such as empyema, lung contusions, and pneumonia.…”

Section: Resultsmentioning

confidence: 99%

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Strauss

Menchetti

Perrier

et al. 2021

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

ObjectivesThe Tactical Combat Casualty Care (TCCC) guidelines detail resuscitation practices in prehospital and austere environments. We sought to review the content and quality of the current TCCC and civilian prehospital literature and characterize knowledge gaps to offer recommendations for future research.MethodsMEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for studies assessing intervention techniques and devices used in civilian and military prehospital settings that could be applied to TCCC guidelines. Screening and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal was conducted using appropriate tools.ResultsNinety-two percent (n=57) of studies were observational. Most randomized trials had low risk of bias, whereas observational studies had higher risk of bias. Interventions of massive hemorrhage control (n=17) were wound dressings and tourniquets, suggesting effective hemodynamic control. Airway management interventions (n=7) had high success rates with improved outcomes. Interventions of respiratory management (n=12) reported low success with needle decompression. Studies assessing circulation (n=18) had higher quality of evidence and suggested improved outcomes with component hemostatic therapy. Hypothermia prevention interventions (n=2) were generally effective. Other studies identified assessed the use of extended focused assessment with sonography in trauma (n=3) and mixed interventions (n=2).ConclusionsThe evidence was largely non-randomized with heterogeneous populations, interventions, and outcomes, precluding robust conclusions in most subjects addressed in the review. Knowledge gaps identified included the use of blood products and concentrate of clotting factors in the prehospital setting.Level of evidenceSystematic review, level III.

show abstract

Section: Resultsmentioning

confidence: 99%

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Strauss

Menchetti

Perrier

et al. 2021

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…A total of 2,177 study subjects were associated with the included articles. There were two Level I systematic reviews, 4,5 33 Level II prospective studies with 647 subjects, seven Level III retrospective studies with 1,455 subjects, [39][40][41][42][43][44][45] and two Level IV case series with four subjects. 46,47 There were two Level V case reports 48,49 and 63 pertinent review articles.…”

Section: Resultsmentioning

confidence: 99%

Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review

Nowadly

Trapp

Richards

2019

Prehosp. Disaster med.

View full text Add to dashboard Cite

Introduction:Provision of critical care and resuscitation was not practical during early missions into space. Given likely advancements in commercial spaceflight and increased human presence in low Earth orbit (LEO) in the coming decades, development of these capabilities should be considered as the likelihood of emergent medical evacuation increases.Methods:PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration (NASA) Technical Server, and Defense Technical Information Center were searched from inception to December 2018. Articles specifically addressing critical care and resuscitation during emergency medical evacuation from LEO were selected. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines.Results:The search resulted in 109 articles included in the review with a total of 2,177 subjects. There were two Level I systematic reviews, 33 Level II prospective studies with 647 subjects, seven Level III retrospective studies with 1,455 subjects, and two Level IV case series with four subjects. There were two Level V case reports and 63 pertinent review articles.Discussion:The development of a medical evacuation capability is an important consideration for future missions. This review revealed potential hurdles in the design of a dedicated LEO evacuation spacecraft. The ability to provide critical care and resuscitation during transport is likely to be limited by mass, volume, cost, and re-entry forces. Stabilization and treatment of the patient should be performed prior to departure, if possible, and emphasis should be on a rapid and safe return to Earth for definitive care.

show abstract

“…57 Several studies from the United States military evacuation of casualties from the conflicts in Iraq and Afghanistan provide some insight into adverse events. 58,59 These trials included mechanically ventilated subjects in cases of non-battle injuries (20%) and battle injuries (60%). In the latter group, subjects were frequently ventilated at settings that did not comply with the ARDSNet tidal volume and PEEP/F IO2 tables.…”

Section: Adverse Events During Interhospital Transportmentioning

confidence: 99%

Monitoring During Transport

Branson

Rodriquez

2020

Respir Care

View full text Add to dashboard Cite

Transport of critically ill patients within and between hospitals is a common undertaking in an effort to improve patient outcomes. Intrahospital transports are frequently conducted to aid in diagnosis through advanced imaging techniques or to allow image-guided procedures. Interhospital transport is most frequently conducted to bring patients to specialized care, including centers of excellence for cardiac, trauma, transplant, and respiratory failure. Transport outside the hospital can be accomplished by ground or air, the latter including fixed-wing and rotor-wing aircraft. Often overlooked, transport of patients from the scene of an accident or illness to the hospital by emergency medical services is less sophisticated but more common than the other methods combined. Patients are also routinely transported to and from the operating room, a form of transport not commonly studied. Risks are inherent to transport, and an analysis of risks and benefits must be part of any risk-mitigation strategy. Monitoring the patient during transport by attendants and equipment is a key component of risk mitigation. Quicker transport times and specialized transport teams are associated with improved outcomes, whereas severity of illness is a harbinger of untoward complications. The type of monitoring during transport varies widely with the environment, the skill of the attendants, and the severity of patient illness. Standards for patient monitoring during transport are available, but they are predominantly based on expert opinion. This paper reviews guidelines and the risks of transport as a template for required monitoring, and it discusses common mishaps associated with transport and how these can be avoided with appropriate monitoring.

show abstract

Impact of Critical Care Air Transport Team (CCATT) ventilator management on combat mortality

Abstract: Therapeutic/care management, level IV.

Cited by 20 publications

References 20 publications

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research

Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review

Monitoring During Transport

Contact Info

Product

Resources

About