Research progress on combat trauma treatment in cold regions

Wang, Huishan; Han, Jaeseok

doi:10.1186/2054-9369-1-8

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…With all these considerations in mind, it is important to remember that managing a hemorrhagic combat casualty in a cold environment involves more than just keeping blood products warm. 28,29 Maintaining the patient's body temperature is crucial to prevent hypothermia, a key part of the lethal triad, which significantly increases mortality risk. [30][31][32][33] Additionally, using tactical hemostatic materials can be challenging due to technical winter clothing, and the mental and physical strain on medical personnel in these conditions is substantial.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Performance of far forward iceless blood storage containers in controlled cold environments

Vuong,

Derkenne,

Travers

et al. 2024

Transfusion

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BackgroundThe Golden Hour Box (GHB), an iceless blood container designed for transfusion closest to the point of injury, is used by military medical teams in remote damage control resuscitation. While its performance is well‐established in hot environments, it remains underexplored in cold conditions, a significant consideration in emerging global conflict zones.Study Design and MethodsFour GHBs were preconditioned at +4°C or +18°C for 8 h and subsequently exposed to controlled laboratory simulated temperatures of −5, −15, and −25°C for 100 h. The study focused on their capability to maintain an internal temperature between +2 and +6°C, the recommended range for red blood cells unit storage and transport, using calibrated sensors for precise monitoring.ResultsWhen exposed to negative Celsius temperatures, GHBs showed varied performance depending on preconditioning temperatures. When preconditioned at +4°C, GHBs maintained an internal temperature within the target range (+2 to +6°C) for 100 h at −5°C, 52 ± 1 h at −15°C, and 29 ± 4 h at −25°C. In contrast, the internal temperature of GHBs preconditioned at +18°C exceeded this range in less than 30 min, then dropped below 2°C more rapidly than those preconditioned at +4°C, occurring within 20 ± 2 h at −15 and 13 ± 1 h at −25°C.ConclusionThe GHB, when properly preconditioned, effectively maintains internal temperatures suitable for blood product transport in extreme cold. Future research, including analyses of blood performances, is still needed to validate these results in more realistic operational conditions for use in cold environments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Performance of far forward iceless blood storage containers in controlled cold environments

Vuong,

Derkenne,

Travers

et al. 2024

Transfusion

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“…Conventional resuscitation strategies for the treatment of exsanguinating traumatic cardiac arrest are poor. Furthermore, when trauma occurs in colder regions, the effect of treatment is lessened [ 1 ]. Although some traumatic injuries can be surgically treated [ 2 ], more than half of the trauma patients in recent military conflicts died because of limited medical care [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

A safety evaluation of profound hypothermia-induced suspended animation for delayed resuscitation at 90 or 120 min

Liu

et al. 2017

Military Med Res

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BackgroundThe successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia-induced suspended animation for delayed resuscitation (SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest (CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals.MethodsSixteen male BAMA minipigs were randomized into two groups: CA90 group (90 min, n = 8) and CA120 group (120 min, n = 8). Cannulation of the right common carotid arteries and internal jugular veins was performed to establish cardiopulmonary bypass for each animal. Through the perfusion of cold organ preservation solution (OPS), cardioplegia and profound hypothermia (15 °C) were induced. After CA, cardiopumonary bypass (CPB) was restarted, and the animals were gradually re-warmed and resuscitated. The animals were assisted with ventilators until spontaneous breathing was achieved. The index of hemodynamic perioperative serum chemistry values [alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine (CR), lactic dehydrogenase (LDH) and troponin T (TnT)] and survival were observed from pre-operation to 7 days post-operation.ResultsFifteen animals were enrolled in the experiment, while 1 animal in CA120 group died from surgical error. All 8 animals in CA90 group recovered, with only 1 animal displaying mild disability. However, in CA120 group, only 2 animals survived with severe disability, and the other 5 animals died after 2 days post-operation. In CA90 group, the perioperative serum chemistry values increased at 1 day post-operation (ALT 84.43 ± 18.65 U/L; AST 88.99 ± 23.19 U/L; Cr 87.90 ± 24.49 μmol/L; LDH 1894.13 ± 322.26 U/L; TnT 0.849 ± 0.135 ng/ml) but decreased to normal or almost normal levels at 7 days post-operation (ALT 52.48 ± 9.04 U/L; AST 75.23 ± 21.46 U/L; Cr 82.69 ± 18.41 μmol/L; LDH 944.67 ± 834.32 U/L; TnT 0.336 ± 0.076 ng/ml).ConclusionsProfound hypothermia-induced SADR is an effective method for inducing cardiac arrest. Our results indicate that inducing CA for 90 min (at 15 °C) is safer than doing so for 120 min. Our results indicate that 120 min of CA at 15 °C is dangerous and can result in high mortality and severe neurological complications. Further experimentation is needed to determine whether 120 min of CA at temperatures lower than 15 °C can lead to safe recovery.

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“…Hypoxia induces vascular endothelial growth factor (VEGF) gene transcription in human osteoblast-like cells through HIF-2α [ 3 ]. Hypoxia induced by fracture significantly upregulates the expression of bone morphogenetic protein 2 (BMP-2), an osteogenic cytokine at the fracture site, in the capillary endothelial cells [ 4 , 5 ]. It is also suggested that endothelial cells may play a role in stimulating MC3T3 cells through the potent osteogenic factor BMP-2, other than in promoting angiogenesis.…”

Section: Introductionmentioning

confidence: 99%

Hypoxia-induced MTA1 promotes MC3T3 osteoblast growth but suppresses MC3T3 osteoblast differentiation

et al. 2015

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BackgroundBone fracture is one of the most common physical injuries in which gene expression and the microenvironment are reprogramed to facilitate the recovery process.MethodsBy specific siRNA transfection and MTT assay, we evaluated the effects of metastasis-associated gene 1 (MTA1) in osteoblast growth. To show the role of MTA1 in osteoblast under hypoxia conditions, by overexpressing and silencing MTA1 expression, we performed mineral deposition and alkaline phosphatase activity assay to observe the differentiation status of osteoblast cells. Real-time PCR and Western blot assays were adopted to detect the expression of certain target genes.ResultsHere, we reported that hypoxia-induced MTA1 expression through hypoxia-induced factor 1 alpha (HIF-1α) and stimulated the growth of osteoblast MC3T3 cells. Silencing of MTA1 through specific siRNA suppressed MC3T3 cell growth and elicited cell differentiation and induced alkaline phosphatase activation and the upregulation of bone morphogenetic protein-2 and osteocalcin.ConclusionsWe found that MTA1 was regulated by HIF-1α in hypoxia circumstance to suppress osteoblast differentiation. These findings provide new insights for bone fracture healing and new strategies to develop potential targets to promote fracture healing.Electronic supplementary materialThe online version of this article (doi:10.1186/s40001-015-0084-x) contains supplementary material, which is available to authorized users.

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Research progress on combat trauma treatment in cold regions

Cited by 5 publications

References 31 publications

Performance of far forward iceless blood storage containers in controlled cold environments

Performance of far forward iceless blood storage containers in controlled cold environments

A safety evaluation of profound hypothermia-induced suspended animation for delayed resuscitation at 90 or 120 min

Hypoxia-induced MTA1 promotes MC3T3 osteoblast growth but suppresses MC3T3 osteoblast differentiation

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