Advanced bleeding control in combat casualty care: An international, expert-based Delphi consensus

Abstract

BACKGROUND: Hemorrhage from truncal and junctional injuries is responsible for the vast majority of potentially survivable deaths in combat casualties, causing most of its fatalities in the prehospital arena. Optimizing the deployment of the advanced bleeding control modalities required for the management of these injuries is essential to improve the survival of severely injured casualties. This study aimed to establish consensus on the optimal use and implementation of advanced bleeding control modalities in combat casualty care. METHODS:A Delphi method consisting of three rounds was used. An international expert panel of military physicians was selected by the researchers to complete the Delphi surveys. Consensus was reached if 70% or greater of respondents agreed and if 70% or greater responded. RESULTS:Thirty-two experts from 10 different nations commenced the process and reached consensus on which bleeding control modalities should be part of the standard equipment, that these modalities should be available at all levels of care, that only trained physicians should be allowed to apply invasive bleeding control modalities, but all medical and nonmedical personnel should be allowed to apply noninvasive bleeding control modalities, and on the training requirements for providers. Consensus was also reached on the necessity of international registries and guidelines, and on certain indications and contraindications for resuscitative endovascular balloon occlusion of the aorta (REBOA) in military environments. No consensus was reached on the role of a wound clamp in military settings and the indications for REBOA in patients with chest trauma, penetrating axillary injury or penetrating neck injury in combination with thoracoabdominal injuries. CONCLUSION: Consensus was reached on the contents of a standard bleeding control toolbox, where it should be available, providers and training requirements, international registries and guidelines, and potential indications for REBOA in military environments.

Prehospital care according to the principles of Damage Control Resuscitation in the conditions of modern warfare (literature review)

“…Продолжительность окклю зии аорты в I зоне не должна превышать 30 мин, что является серьезным ограничением для применения РЭБОА в боевых условиях. Ме тод прерывистой РЭБОА потенциально может увеличить время окклюзии в I зоне до 60 мин и более [16,46].…”

Advances in trauma care to save lives from traumatic injury: A narrative review

“…An analysis of whole blood resuscitation in the United States reported decreased 24-hour mortality, in-hospital mortality, major complications rate, and length of stay 24 . Thus, LTOWB is currently recommended as part of damage-control resuscitation (DCR) 2,25 . In the prehospital and hospital setting, LTOWB is the preferred blood product for resuscitation for life-threatening hemorrhage.…”

“…24 Thus, LTOWB is currently recommended as part of damage-control resuscitation (DCR). 2,25 In the prehospital and hospital setting, LTOWB is the preferred blood product for resuscitation for life-threatening hemorrhage. Very recently, in-hospital LTOWB transfusion was associated with greater survival.…”

“…1 Over the last few decades, investment in trauma care has advanced the holistic understanding of hemorrhagic shock, its management, and the clinical consequences. The knowledge translation from recent military combat experiences 2 and increasing number of mass shooting events and assaults has led trauma teams to manage more penetrating trauma, blast explosions, and complex injuries. 3 In the prehospital environment, severe bleeding will lead to death from exsanguination in the absence of effective life-saving interventions.…”

A novel sodium polyacrylate–based stasis dressing to treat lethal hemorrhage in a penetrating trauma swine model

“…Hemorrhage is a major cause of trauma-related deaths in both combat and the civilian sector. 1 , 2 Time is a critical factor in emergency treatment. The rapid achievement of hemostasis might exert salutary effects on the downstream blood loss by preventing patient hypothermia, acidosis, coagulopathy, and a potentially lethal triad, thereby resulting in superior outcomes for trauma patients.…”