Resuscitation in the Combat Injured - The Eastern Association for the Surgery of Trauma

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Eastern Association for the Surgery of Trauma

Resuscitation in the Combat Injured

Damage control resuscitation.

Cap AP, Pidcoke HF, Spinella P, Strandenes G, Borgman MA, Schreiber M, Holcomb J, Tien HC, Beckett AN, Doughty H, Woolley T, Rappold J, Ward K, Reade M, Prat N, Ausset S, Kheirabadi B, Benov A, Griffin EP, Corley JB, Simon CD, Fahie R, Jenkins D, Eastridge BJ, Stockinger Z

Mil Med. 2018 Sep 1;183(suppl_2):36-43

Rationale for inclusion: Reinforces principles of blood transfusion, minimizing crystalloid, hypotensive resuscitation until hemorrhage control, TXA, avoidance of acidosis and hypothermia. Reviews indicators of need for MTP (vitals, injury, labs, imaging). Discusses storage and usage of blood components.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Expeditionary Resuscitation Surgical Team: the US Army's initiative to provide damage control resuscitation and surgery to forces in austere settings.

D'Angelo M, Losch J, Smith B, Geslak M, Compton S, Wofford K, Seery JM, Morrison M, Wedmore I, Paimore J, Gross K, Cuenca PJ, Welder MD.

Journal of Special Operations Medicine. 17(4):76-79, Winter 2017.

Rationale for inclusion: Discusses one of the most recent advances in far forward care, the highly mobile ERST.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Fluid resuscitation in tactical combat casualty care: yesterday and today.

Butler FK Jr.

Wilderness & Environmental Medicine. 28(2S):S74-S81, 2017 Jun.

Rationale for inclusion: Review timeline of updates in resuscitation. Previously 2L crystalloid was the choice for initial resuscitation. New guidelines- emphasize whole blood, followed by component therapy, with crystalloid as last choice. No fluids if radial pulse strong and normal mental status.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Augmentation of point of injury care: Reducing battlefield mortality-The IDF experience.

Benov Avi, Elon G, Baruch EN, Avi S, Gilad T, Moran L, Itay Z, Ram S, Tarif B, David D, Avraham Y, Yitshak K

Injury. 2016 May;47(5):993-1000

Rationale for inclusion: Information from IDF MC on incorporation of a physician or paramedic into each fighting company, implementation of new CPGs, introduction of new approaches for extremity haemorrhage control and Remote Damage Control Resuscitation at point of injury (POI) using single donor reconstituted FDP and TXA. Impact on outcomes.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Resuscitative endovascular balloon occlusion of the aorta for hemorrhage control: Past, present, and future

Belenkiy, SM, Batchinsky AI, Rasmussen TE, Cancio LC

Journal of Trauma and Acute Care Surgery. 79(4 Supp 2):S236-S242, October 2015.

Rationale for inclusion: Discusses the evolution of REBOA, and the potential for implementation in far forward deployed environments. Origin in the Korean War. More experience developed from non-trauma emergencies (GI bleed, ruptured AAA). Multiple animal studies comparied REBOA and EDT for aortic occlusions for hemorrhagic shock. Ongoing innovation for allow implementation in far forward environment.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Freeze-dried plasma at the point of injury: from concept to doctrine.

Glassberg E, Nadler R, Gendler S, Abramovich A, Spinella PC, Gerhardt RT, Holcomb JB, Kreiss Y.

Shock. 40(6):444-50, 2013 Dec.

Rationale for inclusion: Discussed the implementation of freeze dried plasma in austere environments

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Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study.

Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ.

Arch Surg. 2012 Feb;147(2):113-9.

Rationale for inclusion: This is the first military study on the use of TXA in conjunction with blood component-based resuscitation in combat casualties. Improved survival was seen in those patients who received TXA and was more prominent in those requiring massive transfusion.

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Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries.

Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Holcomb JB.

J Trauma. 2009 Apr;66(4 Suppl):S69-76.

Rationale for inclusion: The military experience with fresh whole blood transfusions is largely out of necessity due to the inability to store adequate component products at forward surgical units. This retrospective study demonstrates that there is a survival advantage to WFWB transfusion in patients with hemorrhagic shock.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

An evaluation of the impact of apheresis platelets used in the setting of massively transfused trauma patients.

Perkins JG, Cap AP, Spinella PC, Blackbourne LH, Grathwohl KW, Repine TB, Ketchum L, Waterman P, Lee RE, Beekley AC, Sebesta JA, Shorr AF, Wade CE, Holcomb JB.

J Trauma. 2009 Apr;66(4 Suppl):S77-84; discussion S84-5.

Rationale for inclusion: This study represents a large cohort of patients treated at a combat hosptial in Iraq. Those requiring massive transfusion who received apheresed platelets in high aPLT:RBC ratio > 1:8 had improved survival.

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Increased mortality associated with the early coagulopathy of trauma in combat casualties.

Niles SE, McLaughlin DF, Perkins JG, Wade CE, Li Y, Spinella PC, Holcomb JB.

J Trauma. 2008 Jun;64(6):1459-63; discussion 1463-5.

Rationale for inclusion: In this retrospective review of combat trauma patients, acute coagulopathy was associated with mortality, similar to civilian trauma patients.

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The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an army combat support hospital.

Stinger HK, Spinella PC, Perkins JG, Grathwohl KW, Salinas J, Martini WZ, Hess JR, Dubick MA, Simon CD, Beekley AC, Wolf SE, Wade CE, Holcomb JB.

J Trauma. 2008 Feb;64(2 Suppl):S79-85; discussion S85.

Rationale for inclusion: In combat trauma patients who were found to need massive transfusion and also received higher ratios of fibrinogen:RBC there was increased survival.

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Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital.

Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, Jenkins D, Azarow K, Holcomb JB; 31st Combat Support Hospital Research Working Group.

Crit Care Med. 2007 Nov;35(11):2576-81.

Rationale for inclusion: The use of WFWB transfusion, especially in combat resusciation, is known to incur a survival advantage. Concerns over safety of FWB tranfsusion exist. This study shows that the risk of infection disease transmission can be minimized for FWB transfusion in a pre-screened miiltary combat environment.

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The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital.

Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, Jenkins D, Wade CE, Holcomb JB.

J Trauma. 2007 Oct;63(4):805-13.

Rationale for inclusion: This retrospective review of combat patients requiring massive tranfusion showed that those who received high plasma to PRBC ratios had improved survival. This is clearly a landmark paper that significantly impacted both military and civilian blood resuscitation therapy and massive transfusion protocols.

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Early predictors of massive transfusion in combat casualties.

Schreiber MA, Perkins J, Kiraly L, Underwood S, Wade C, Holcomb JB.

J Am Coll Surg. 2007 Oct;205(4):541-5.

Rationale for inclusion: This is retrospective review of combat patients requiring massive transfusion. Massive transfusion in this group was associated with higher mortality, and variable present early upon admission can predict the need for massive transfusion.

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Damage control resuscitation: directly addressing the early coagulopathy of trauma.

Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, Cox ED, Gehrke MJ, Beilman GJ, Schreiber M, Flaherty SF, Grathwohl KW, Spinella PC, Perkins JG, Beekley AC, McMullin NR, Park MS, Gonzalez EA, Wade CE, Dubick MA, Schwab CW, Moore FA, Champion HR, Hoyt DB, Hess JR.

J Trauma. 2007 Feb;62(2):307-10.

Rationale for inclusion: Although this is a commentary, it represents one of the earliest and most recognized discussions of damage control resusctation.

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