Injury pattern and mortality of noncompressible torso hemorrhage in UK combat casualties

Abstract

This study demonstrates that the majority of patients sustaining NCTH die before hospital admission, with exsanguination and central nervous system disruption contributing to the bulk cause of death. Major arterial and pulmonary hilar injuries are independent predictors of mortality.

Resuscitative endovascular balloon occlusion of the aorta (REBOA): What have we learned?

“…It could be mediated by the restriction of arterial tree and the effect of circulating catecholamines and has a potential of harm to myocardial perfusion and respiratory function, besides a raised intracranial pressure. This last issue is of particular importance, since many candidates for REBOA sustain a brain injury (9)(10)(11). Thus, redistribution of the excess of output in the areas proximal to the balloon while some degree of distal perfusion is maintained is of paramount importance.…”

“…Most of deaths in trauma patients take place in the prehospital setting (7)(8)(9)(10). They are usually related to hemorrhage and could be preventable, which raises the question of deploying REBOA in the pre hospital setting (42,43).…”

“…Hemorrhage is the main cause of preventable death in both military and civilian trauma patients, thus affecting a young and otherwise healthy population (7)(8)(9)(10)(11)(12). This fact remains unchanging despite heterogeneity of the samples reported in terms of trauma event, injury pattern and care resources available.…”

Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta

“…Hemorrhagic shock is a well-recognized cause of preventable deaths in both military (1,2) and civilian trauma (3). Non-compressible torso hemorrhage (NCTH) is a more specific entity of shock to which more attention should be paid (4).…”

Defining the essential anatomical coverage provided by military body armour against high energy projectiles

“…Such injuries remain the leading cause of potentially survivable deaths on the modern battlefield 1–7. Bleeding from projectiles penetrating the thoracic cavity in particular is difficult to treat as it is not amenable to compression by applying direct pressure 1. Although modern haemostatic dressings and the early use of blood products can potentially delay the time to death or significant complications8–11 the only way of definitively stopping ongoing intrathoracic bleeding remains surgery 12.…”