The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2019
Prehospital adenosine, lidocaine, and magnesium has inferior survival compared with tactical combat casualty care resuscitation in a porcine model of prolonged hemorrhagic shock.
Adenosine, lidocaine, and magnesium (ALM) is a cardioplegic agent shown to improve survival by improving cardiac function, tissue perfusion, and coagulopathy in animal models of shock. We hypothesized prehospital ALM treatment in hemorrhagic shock would improve survival compared to current Tactical Combat Casualty Care (TCCC) resuscitation beyond the golden hour. ⋯ Adenosine, lidocaine, and magnesium, as administered in this study, are inferior to current Hextend-based resuscitation for survival from prolonged hemorrhagic shock in this model. In survivors, ALM groups had lower systolic blood pressures and MAPs, but provided a protective effect on coagulopathy as compared to TCCC. Adenosine, lidocaine, and magnesium do not appear to be a suitable low volume replacement to current TCCC resuscitation. The reduced coagulopathy compared to TCCC warrants future studies of ALM, perhaps as a therapeutic adjunct.
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J Trauma Acute Care Surg · Jul 2019
Unplanned readmission after traumatic injury: A long-term nationwide analysis.
Long-term outcomes after trauma admissions remain understudied. We analyzed the characteristics of inpatient readmissions within 6 months of an index hospitalization for traumatic injury. ⋯ Epidemiological study, level III.
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J Trauma Acute Care Surg · Jul 2019
Historical ArticleArtificial oxygen carriers and red blood cell substitutes: A historic overview and recent developments toward military and clinical relevance.
Packed red blood cells are a critical component in the resuscitation of hemorrhagic shock. The availability of donor-derived blood products, however, suffers from issues of supply, immunogenicity, and pathogenic contamination. Deployment in remote or austere environments, such as the battlefield, is further hindered by the inherent perishability of blood products. ⋯ This article provides a comprehensive review of the most important technologies in the field of artificial oxygen carriers including cell-free and encapsulated hemoglobin-based oxygen carriers, perfluorocarbon emulsions, natural hemoglobin alternatives, as well as other novel technologies. Their development status, clinical, and military relevance are discussed. LEVEL OF EVIDENCE: Systematic review.
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J Trauma Acute Care Surg · Jul 2019
Defining geographic emergency medical services coverage in trauma systems.
Geographic distribution of trauma system resources including trauma centers and helicopter bases correlate with outcomes. However, ground emergency medical services (EMS) coverage is dynamic and more difficult to quantify. Our objective was to evaluate measures that describe ground EMS coverage in trauma systems and correlate with outcome. ⋯ Ecological study, level IV.
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J Trauma Acute Care Surg · Jul 2019
Preventable death and interpersonal violence in the United States: Who can be saved?
Public health initiatives to reduce mortality from penetrating trauma have largely developed from patterns of injury observed in military casualties, with a focus on hemorrhage control and use of tourniquets. Recent efforts show that injury patterns differ between civilian mass casualty events and combat settings, and no studies characterize wounding patterns in all types of civilian homicide. We hypothesize that many homicide deaths are due to nonsurvivable injuries, and that an effective strategy to reduce mortality must focus on both primary prevention as well as improvement in trauma prehospital care. ⋯ Epidemiological study, level IV.