Prehospital interventions performed in a combat zone

Lairet, Julio; Bebarta, Vikhyat S.; Burns, Christopher J.; Lairet, Kimberly; Rasmussen, Todd E.; Renz, Evan M.; King, Booker T.; Fernandez, William G.; Gerhardt, Robert T.; Butler, Frank K.; DuBose, Joseph J.; Cestero, Ramon F.; Salinas, José; Torres, Pedro; Minnick, J.T.; Blackbourne, Lorne H.

doi:10.1097/ta.0b013e3182606022

Cited by 76 publications

(21 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, NS is associated with vasodilator effects and the risks of metabolic acidosis and hyperkalemia. Currently, military first responders have NS, LR and Hextend available [20]. However, the results from the current study and our recent study [38] suggest that all of these fluids have limitations in managing hemodynamics, metabolic responses, and coagulation.…”

Section: Discussionmentioning

confidence: 61%

“…It is unclear whether the hypercoagulability is transient or is likely to be a concern. On the other hand, a recent multicenter survey of prehospital intervention at a combat zone showed that IV fluids administered in the field favored the use of NS by 73% to 17% LR [20], even though Hextend® (manufactured by BioTime, California, USA, with 6% hetastarch, a mean molecular weight of 670 kD and a degree of hydroxyethyl group substitution of 0.75 (HES 670/0.75)) is the fluid recommended by the Committee on Tactical Combat Casualty Care [21]. In addition, the Israeli Defense Force has recently recommended LR as initial resuscitation of their combat casualties [22].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the Israeli Defense Force has recently recommended LR as initial resuscitation of their combat casualties [22]. Thus, the greater use of NS by medics than the recommendation for Hextend® [20,21], recommendation for pre-hospital LR by the Israeli Defense Force [22], and the inquiry from the US Army’s Combat Developer’s office regarding NS vs. LR for pre-hospital resuscitation, all together prompted this current study. In order to assess more comprehensively the physiological and biochemical effects of LR and NS, we compared the resuscitative effects of LR and NS on hemodynamics, oxygen metabolism, and coagulation in a swine model with severe hemorrhagic shock over a 6 h post resuscitation period; the time period in which most trauma patients die from hemorrhage [23].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparisons of normal saline and lactated Ringer’s resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock

Martini

Cortez

Dubick

2013

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

BackgroundOngoing improvements in trauma care now recommend earlier use of blood products as part of damage control resuscitation, but generally these products are not available at far forward battlefield locations. For the military, questions continue to arise regarding efficacy of normal saline (NS) vs. lactated Ringer’s (LR). Thus, this study compared the effects of LR and NS after severe hemorrhage in pigs.Methods20 anesthetized pigs were randomized into control (n = 6), LR (n = 7), and NS (n = 7) groups. Hemorrhage of 60% estimated total blood volume was induced in LR and NS groups by removing blood from the left femoral artery using a computer-controlled pump. Afterwards, the pigs were resuscitated with either LR at 3 times the bled volume or the volume of NS to reach the same mean arterial pressure (MAP) as in LR group. Hemodynamics were measured hourly and blood samples were taken at baseline (BL), 15 min, 3 h and 6 h after resuscitation to measure changes in coagulation using thrombelastograph®.ResultsMAP was decreased by hemorrhage but returned to BL within 1 h after resuscitation with LR (119 ± 7 ml/kg) or NS (183 ± 9 ml/kg, p < 0.05). Base excess (BE) was decreased by hemorrhage; resuscitation with LR recovered BE but not with NS. Total peripheral resistance was decreased with NS and LR, with a larger drop shown in NS. Serum potassium was increased with NS, but not affected with LR. Coagulation changes were similar between LR and NS.ConclusionsNS may be inferior to LR in resuscitation due to its vasodilator effects and the risks of metabolic acidosis and hyperkalemia.

show abstract

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparisons of normal saline and lactated Ringer’s resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock

Martini

Cortez

Dubick

2013

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…[37] This is in contrast to one recent study that suggested that airway and chest lifesaving interventions were most frequently missed in combat situations. [38] No matter what current outcomes data may imply, it is reasonable to expect that improved protocols and rigorous training standards should improve prehospital airway management in combat situations.…”

Section: Introductionmentioning

confidence: 99%

Advances in prehospital airway management

Jacobs

Grabinsky

2014

Int J Crit Illn Inj Sci

View full text Add to dashboard Cite

Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.

show abstract

“…As a comparative control, we used 0.9% saline. The choice of saline over the other crystalloids, such as Ringer's solution, was based on a report that normal saline is preferred over Ringer's lactate for the pre-hospital intervention in a combat zone (Lairet et al, 2012). Moreover, we employed isovolemic infusion because it has been shown that compared to aggressive fluid overloading, mildly hypotensive resuscitation increases the survival rates in a rat model of hemorrhagic shock (Li et al, 2012).…”

Section: Methodsmentioning

confidence: 99%

Nanovesicular liposome-encapsulated hemoglobin (LEH) prevents multi-organ injuries in a rat model of hemorrhagic shock

Yadav

Rao

Houson

et al. 2016

European Journal of Pharmaceutical Sciences

View full text Add to dashboard Cite

The goals of resuscitation in hemorrhagic shock are to correct oxygen deficit and to maintain perfusion pressure to the vital organs. We created liposome-encapsulated hemoglobin (LEH) as a nanoparticulate oxygen carrier (216 ± 2 nm) containing 7.2 g/dL hemoglobin, and examined its ability to prevent the systemic manifestations of hemorrhagic shock (45% blood loss) in a rat model. We collected plasma after 6 h of shock and LEH resuscitation, and determined the circulating biomarkers of systemic inflammation and functions of liver, gut, heart, and kidney. As is typical of the shock pathology, a significant increase in the plasma levels of cardiac troponin, liver function enzymes, soluble CD163 (macrophage activation), and creatinine, and the liver/gut myeloperoxidase activity was observed in the hemorrhaged rats. The plasma levels of TNF-α, IL-6, IL-1α, CINC-1, and IL-22 also increased after hemorrhagic shock. LEH administration prevented the hemorrhagic shock-induced accumulation of the markers of injury to the critical organs and pro-inflammatory cytokines. LEH also decreased the plasma levels of stress hormone corticosterone in hemorrhaged rats. Although saline also reduced the circulating corticosterone and a few other tissue injury markers, it was not as effective as LEH in restraining the plasma levels of creatinine, alanine transaminase, CD163, TNF-α, IL-6, and IL-1α. These results indicate that resuscitation with nanoparticulate LEH creates a pro-survival phenotype in hemorrhaged rats, and because of its oxygen-carrying capacity, LEH performs significantly better than saline in hemorrhagic shock.

show abstract

Prehospital interventions performed in a combat zone

Cited by 76 publications

References 12 publications

Comparisons of normal saline and lactated Ringer’s resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock

Comparisons of normal saline and lactated Ringer’s resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock

Advances in prehospital airway management

Nanovesicular liposome-encapsulated hemoglobin (LEH) prevents multi-organ injuries in a rat model of hemorrhagic shock

Contact Info

Product

Resources

About