State‐of‐the‐art methods for the treatment of severe hemorrhagic trauma: selective aortic arch perfusion and emergency preservation and resuscitation—what is next?

Abstract

Trauma is a primary cause of death globally, with non‐compressible torso hemorrhage constituting an important part of “potentially survivable trauma death.” Resuscitative endovascular balloon occlusion of the aorta has become a popular alternative to aortic cross‐clamping under emergent thoracotomy for non‐compressible torso hemorrhage in recent years, however, it alone does not improve the survival rate of patients with severe shock or traumatic cardiac arrest from non‐compressible torso hemorrhage. Development of novel advanced maneuvers is essential to improve these patients’ survival, and research on promising methods such as selective aortic arch perfusion and emergency preservation and resuscitation is ongoing. This review aimed to provide physicians in charge of severe trauma cases with a broad understanding of these novel therapeutic approaches to manage patients with severe hemorrhagic trauma, which may allow them to develop lifesaving strategies for exsanguinating trauma patients. Although there are still hurdles to overcome before their clinical application, promising research on these novel strategies is in progress, and ongoing development of synthetic red blood cells and techniques that reduce ischemia‐reperfusion injury may further maximize their effects. Both continuous proof‐of‐concept studies and translational clinical evaluations are necessary to clinically apply these hemostasis approaches to trauma patients.

From Molecule and Cell to Whole Body Recovery after Warm Ishemia - the Techniques from Organex Perfusion to Emergency Preversation Resusicitation

“…Hypovolemia and hypoperfusion result in contraction of peripheral circulation and a decrease in body temperature. [1,3,5] Hypothermia secondary to hemorrhagic shock is often an independent risk factor for death. Metabolic acidosis and hypothermia can jointly aggravate the coagulation dysfunction, while thrombocytopenia and consumptive coagulation disorder can lead to further bleeding in patients with severe trauma and accelerate the process of shock.…”

“…Metabolic acidosis and hypothermia can jointly aggravate the coagulation dysfunction, while thrombocytopenia and consumptive coagulation disorder can lead to further bleeding in patients with severe trauma and accelerate the process of shock. Lethal triad acidosis, hypothermia and coagulation dysfunction interact and promote each other, and when they do, death is imminent [1,3,5]. However, the above-mentioned organ perfusion and cardiocerebral deep hypothermia perfusion protection, whether at the cellular and molecular level or the overall recovery including brain function, all of these experiments have properly applied hypothermia protection technology.…”

“…The way of hypothermia perfusion management mode and method of controlling temperature in resuscitation still need to be explored, the effects of hypothermia on cardiac function, coagulation function, immune function and drug metabolism still need to be further studied. [1,8] In the systemic hypothermic perfusion experiments, tissues and organs function can recover and even brain function can recover, untill now, it remain unclear whether the organ protective pre-filling fluid, including extracellular and intracellular fluids, synthetic red blood cells, fluorocarbon, and other oxygen-carryier fluids, can better protect the function of tissues and cells, even the function of nervous system, to prolong the time for wound repair in tissues and organs. [1,3] It still need to be explored whether antioxidants, anti-apoptotic agents and other agents in the organEx system can reduce ischemia-reperfusion injury and prolong the tissue repair time during emergency preservation and resuscitation.…”

“…The latter emphasized organ protection by emergency hypothermia perfusion after cardiac arrest, deep hypothermic circulatory arrest, wound repair, and cardiopulmonary bypass perfusion to achieve complete recovery of the body and brain function. [1][2][3][4] Both of them have successfully applied the cryogenic technology of extracorporeal circulation. What inspiration and imagine can they bring us?…”

UK Field Medical Care 2032: one Military Vision

“…Transfusion of artificial blood is keeping up with the amount of blood loss, so suspended animation is not necessary. A self-powered battlefield ICU transfer-drone with integral CT-scanner is requested and lifts off from the nearby medical logistics base nearby, expected arrival 7 min 19–22…”