Thoracic Trauma: a Combat and Military Perspective

Kuckelman, John; Cuadrado, Daniel G.; Martin, Matthew J.

doi:10.1007/s40719-018-0112-8

Cited by 12 publications

(14 citation statements)

References 57 publications

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“…In United States (US) military conflicts in Afghanistan and Iraq, from October 2001 to June 2011, 90% of combat casualties died prior to arrival at surgical facilities, and about 90% of potentially survivable deaths were due to hemorrhage with 67%, 19%, and 14% from truncal, junctional locations, and extremity wounds, respectively. 56,57 A study of Canadian Armed Forces members found that the leading cause of death in soldiers in Afghanistan was hemorrhage at 38% of total deaths, followed by neurologic injury at 33% and blast injuries at 16%. 58 Primary reasons for this included a lack of knowledge on TIC and optimal assessment and treatment of severe bleeding.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

et al. 2021

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“…рисунок 2). Є свідоцтва, що застосування РТ супроводжується виживанням в 11 % у разі бойової травми [1,2,3].…”

Section: таблиця 1 загальна характеристика випадків ушкодження органі...unclassified

“…Під час аналізу пацієнтів не завжди враховувалися поранення інших органів і частин тіла. ністю діагностичних і лікувальних можливостей більшості передових госпіталів [1,2,3,10]. Noncompressible torso (abdominal and thoracic) hemorrhage (NCTH) -грудна (черевна та грудна) кровотеча, що не піддається контролю засобами компресії чи тампонування.…”

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“…Поняття стосується ситуації, коли неможливо контролювати кровотечу з огляду на локалізацію ураженої судини. Зокрема, якщо турнікет є ефективним тимчасовим засобом зупинки кровотечі з артерій кінцівок, то в разі поранень великих судин тулуба таке майже неможливо (рисунок 1) [3].…”

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Experience in the Treatment of Wounds of Circulatory Organs in the Chest and Main Vessels of Other Localizations in Wartime

Hrabovskyy

2022

ujcvs

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The article presents the principles of providing care for injuries to the heart, aorta, pulmonary artery, or other main vessels. The described principles can be applied in the treatment of civil injuries. The aim. Consider a treatment tactic in the cases of heart and main vessels combat injuries using own experience. Materials and methods. Twelve cases of combat wounds of blood circulation organs in the chest were analyzed: 5 gunshot injuries of the subclavian vessels, 4 gunshot injuries of the heart, 1 gunshot injury of the ascending aorta, 1 gunshot injury of the pulmonary artery and 1 suspected gunshot injury of the left ventricle. Also we analyzed 78 cases of combat gunshot injuries of main vessels of other locations: 3 injuries of vessels of the neck, 68 injuries of main vessels of limbs, 6 injuries of iliac arteries, 1 injury of abdominal aorta. Most of the operations, with the exception of those that required artificial blood circulation, were performed in advanced hospitals at the II level of military medical evacuation, which enabled to shorten the time from injury to the performance of the final surgical intervention and save life or limbs. Results and discussion. Two cases with penetrating wounds to the chest and damage to the subclavian vessels were fatal. Death was attributed to uncontrolled chest bleeding. Among the 78 cases of injury of main vessels of other locations, one case with damage to the iliac arteries was fatal, and death also occurred as a result of uncontrolled massive intra-abdominal bleeding. Conclusions. Wounded individuals with unstable hemodynamics against the background of ongoing massive bleeding and with suspicion of injury of the heart or main vessels in the chest should be operated on immediately. Due to the urgency of performing such operations and impossibility of an adequate additional examination, localization and degree of the damage to the organs of the circulatory system is determined during the operation. A thoracoscopic approach can be used in stable patients with non-penetrating gunshot wounds to the heart. In the relatively stable condition of patients with an established injury of the heart, aorta, or pulmonary artery, it is advisable to perform additional examinations. Patients with trauma to the main vessels of the extremities and ischemia thereof need rapid revascularization.

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“…Thoracic injuries account for 80% of preventable deaths in the battlefield [1]. In the civilian environment, chest injuries account for 20-25% of all trauma-related deaths in the USA [2].…”

Section: Introductionmentioning

confidence: 99%

Validation Study of a Novel Chest Tube Placement Device: Comparison of Procedure Time and Lung Injury Risk Between the JD Hook^® Device and Conventional Chest Tube Placement Devices

Durrani

2021

J Curr Surg

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Background:We tested the operational characteristics of JD Hook ® prototype device and compared it to currently available direct chest tube insertion (non-Seldinger) devices in terms of procedure time, safety and risk of lung injury.Methods: Two commercially chest tube devices including a 28 Fr chest tube with trocars, a 24 Fr chest tube with a Kelly forceps clamp and JD Hook ® prototype pleural access device were tested on standard thoracic manikin, for comparative procedure time and risk of lung injury.Results: JD Hook ® pleural access device showed the shortest procedure time with least risk of lung injury compared to conventional access devices. Both results were statistically significant.Conclusions: JD Hook ® device is a safer and faster access device compared to conventional chest tube access devices. Additional studies in animal and cadavers models are needed to validate these results for clinical applications.

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Thoracic Trauma: a Combat and Military Perspective

Cited by 12 publications

References 57 publications

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

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

Experience in the Treatment of Wounds of Circulatory Organs in the Chest and Main Vessels of Other Localizations in Wartime

Validation Study of a Novel Chest Tube Placement Device: Comparison of Procedure Time and Lung Injury Risk Between the JD Hook^® Device and Conventional Chest Tube Placement Devices

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Thoracic Trauma: a Combat and Military Perspective

Cited by 12 publications

References 57 publications

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

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

Experience in the Treatment of Wounds of Circulatory Organs in the Chest and Main Vessels of Other Localizations in Wartime

Validation Study of a Novel Chest Tube Placement Device: Comparison of Procedure Time and Lung Injury Risk Between the JD Hook® Device and Conventional Chest Tube Placement Devices

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Product

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About

Validation Study of a Novel Chest Tube Placement Device: Comparison of Procedure Time and Lung Injury Risk Between the JD Hook^® Device and Conventional Chest Tube Placement Devices