Mortality review of US Special Operations Command battle-injured fatalities

Mazuchowski, Edward L.; Kotwal, Russ S; Janak, Jud C.; Howard, Jeffrey T.; Harcke, H. Theodore; Montgomery, Harold R; Butler, Frank K.; Holcomb, John B.; Eastridge, Brian J.; Gurney, Jennifer M; Shackelford, Stacy

doi:10.1097/ta.0000000000002610

Cited by 45 publications

(76 citation statements)

References 12 publications

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“…62 Similarly, a recent comprehensive analysis of US Special Operations Command battle-injured fatalities found that time to surgery and prehospital blood transfusion were the primary opportunities for improvement to increase survivability. 63 These findings strongly support prehospital transfusion in this setting. Therefore, hemostatic agents for prehospital and early in-hospital administration are particularly important.…”

Section: Discussionmentioning

confidence: 53%

“…Among medically evacuated US combat causalities in Afghanistan, blood product transfusion prehospital was associated with greater 24‐h and 30‐day survival than delayed transfusion or no transfusion 62 . Similarly, a recent comprehensive analysis of US Special Operations Command battle‐injured fatalities found that time to surgery and prehospital blood transfusion were the primary opportunities for improvement to increase survivability 63 . These findings strongly support prehospital transfusion in this setting.…”

Section: Discussionmentioning

confidence: 80%

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Ex vivo hemostatic and immuno‐inflammatory profiles of freeze‐dried plasma

et al. 2021

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Background Hemorrhage is a leading cause of preventable death in civilian and military trauma. Freeze‐dried plasma is promising for hemostatic resuscitation in remote prehospital settings, given its potential benefits in reducing blood loss and mortality, long storage at ambient temperatures, high portability, and rapid reconstitution for transfusion in austere environments. Here we assess the ex vivo characteristics of a novel Terumo's freeze‐dried plasma product (TFDP). Study design and methods Rotational thromboelastometry (ROTEM) tests (INTEM, EXTEM, and FIBTEM) were conducted on plasma samples at 37°C with a ROTEM delta‐machine using standard reagents and procedures. The following samples were analyzed: pooled plasma to produce TFDP, TFDP reconstituted, and stored immediately at −80°C, reconstituted TFDP stored at 4°C for 24 h and room temperature (RT) for 4 h before freezing at −80°C. Analysis of plasma concentrations of selected cytokines, chemokines, and vascular molecules was performed using a multiplex immunoassay system. One‐way ANOVA with post hoc tests assessed differences in hemostatic and inflammatory properties. Results No significant differences in ROTEM variables (coagulation time [CT], clot formation time, α‐angle, maximum clot firmness, and lysis index 30) between the TFDP‐producing plasma and reconstituted TFDP samples were observed. Compared to control plasma, reconstituted TFDP stored at 4°C for 24 h or RT for 4 h showed a longer INTEM CT. Levels of immuno‐inflammatory mediators were similar between frozen plasma and TFDP. Conclusions TFDP is equivalent to frozen plasma with respect to global hemostatic and immuno‐inflammatory mediator profiles. Further investigations of TFDP in trauma‐induced coagulopathy models and bleeding patients are warranted.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 80%

Ex vivo hemostatic and immuno‐inflammatory profiles of freeze‐dried plasma

et al. 2021

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“…Hemorrhage remains to be the principal cause of preventable death on the battle eld [1,2]. A variety of technologies have been directed toward control of bleeding including tourniquets, direct pressure, hemostatic dressings, and circulatory volume replacement [3,4].…”

Section: Introductionmentioning

confidence: 99%

Remote Ischemic Preconditioning Improves Tissue Oxygenation in a Porcine Model of Controlled Hemorrhage Without Fluid Resuscitation

Yaniv

Eisenkraft

Gavish

et al. 2021

Preprint

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Purpose Remote Ischemic preconditioning (RIPC) involves deliberate, brief interruptions of blood flow to increase the tolerance of distant critical organs to ischemia. This study tests the effects of limb RIPC in a porcine model of controlled hemorrhage without replacement therapy simulating an extreme field situation of delayed evacuation to definitive care.Methods Twenty-eight pigs (47±6kg) were assigned to: (1) control, no procedure (n=7); (2) HS=hemorrhagic shock (n=13); and (3) RIPC+HS=remote ischemic preconditioning followed by hemorrhage (n=8). The animals were observed for 7 hours after bleeding without fluid replacement. Results Survival rate between animals that underwent RIPC before bleeding and those bled without prior RIPC were similar (HS, 6 of 13[46%]-vs-RIPC+HS, 4 of 8[50%], p=0.86 by Chi-square). Animals with prior RIPC had faster recovery of mean arterial pressure and developed higher heart rates without complications. Those with RIPC had less decrease in pH and bicarbonate, and the increase in lactate began later. Global oxygen delivery was higher, and tissue oxygen extraction ratio lower, in animals bled after RIPC. Conclusions These improvements after RIPC in hemodynamic and metabolic status provide essential substrates for improved cellular response after hemorrhage and reduction of the likelihood of potentially catastrophic consequences of the accompanying ischemia.

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“…Hemorrhage remains to be the principal cause of preventable death on the battlefield 1 , 2 . A variety of technologies have been directed toward control of bleeding including tourniquets, direct pressure, hemostatic dressings, and circulatory volume replacement 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Remote ischemic preconditioning improves tissue oxygenation in a porcine model of controlled hemorrhage without fluid resuscitation

Gal

Eisenkraft

Gavish

et al. 2021

Sci Rep

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Remote ischemic preconditioning (RIPC) involves deliberate, brief interruptions of blood flow to increase the tolerance of distant critical organs to ischemia. This study tests the effects of limb RIPC in a porcine model of controlled hemorrhage without replacement therapy simulating an extreme field situation of delayed evacuation to definitive care. Twenty-eight pigs (47 ± 6 kg) were assigned to: (1) control, no procedure (n = 7); (2) HS = hemorrhagic shock (n = 13); and (3) RIPC + HS = remote ischemic preconditioning followed by hemorrhage (n = 8). The animals were observed for 7 h after bleeding without fluid replacement. Survival rate between animals of the RIPC + HS group and those of the HS group were similar (HS, 6 of 13[46%]-vs-RIPC + HS, 4 of 8[50%], p = 0.86 by Chi-square). Animals of the RIPC + HS group had faster recovery of mean arterial pressure and developed higher heart rates without complications. They also had less decrease in pH and bicarbonate, and the increase in lactate began later. Global oxygen delivery was higher, and tissue oxygen extraction ratio lower, in RIPC + HS animals. These improvements after RIPC in hemodynamic and metabolic status provide essential substrates for improved cellular response after hemorrhage and reduction of the likelihood of potentially catastrophic consequences of the accompanying ischemia.

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Mortality review of US Special Operations Command battle-injured fatalities

Cited by 45 publications

References 12 publications

Ex vivo hemostatic and immuno‐inflammatory profiles of freeze‐dried plasma

Ex vivo hemostatic and immuno‐inflammatory profiles of freeze‐dried plasma

Remote Ischemic Preconditioning Improves Tissue Oxygenation in a Porcine Model of Controlled Hemorrhage Without Fluid Resuscitation

Remote ischemic preconditioning improves tissue oxygenation in a porcine model of controlled hemorrhage without fluid resuscitation

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