Archive for October, 2015

NTI Studies Gain $1 Million in Funding from the Joint Warfighter Medical Research Program

Wednesday, October 28th, 2015

Funding from the Joint Warfighter Medical Research Program will support the continuation of two studies initially funded by the National Trauma Institute. Deemed to have significance for pre-hospital treatment of the war wounded, the studies by Jay Doucet, MD, University of California at San Diego, and Henry Cryer, MD, University of California at Los Angeles, were selected on the strength of their preliminary results.

Dr. Doucet’s study, Detection and Management of Non-Compressible Hemorrhage Using Vena Cava Ultrasound, postulates that ultrasonic assessment of the inferior vena cava (IVC) can detect and aid management of non-compressible hemorrhage in major trauma victims. As indicated in small clinical studies, observation of the diameter of IVC in both expiration and inspiration, as well as its collapsibility, can be a sensitive indicator of blood volume loss and hemorrhagic shock. Doucet’s study specifically aims to determine how accurate ultrasound assessment of the IVC is, compared to vital signs, as well as the measure’s ability to detect preclinical shock states.

This technique may predict those patients who will require transfusions, surgery or angiographic embolization. Additionally, the study will provide an opportunity to demonstrate the ability of handheld ultrasound devices to detect and monitor hemorrhagic shock in initial trauma care and in the ICU in both civilian and military trauma environments.

The investigation being led by Dr. Cryer, Transfusion Using Stored Fresh Whole Blood (FWB), will determine the appropriate shelf life of FWB by measuring changes in levels of coagulation factors and global clotting potential of banked units over time. Dr. Cryer’s earlier results demonstrated that filtered blood has a filtration lesion resulting in a coagulopathic product and some decrease in clotting capability over 35 days. Platelet transfusion may correct the filtration lesion seen, but further studies are needed to determine the exact timing and ratio of platelet transfusion required.

The follow-on effort will prospectively determine the effectiveness of trauma resuscitation using FWB compared to component therapy and its effects on markers of coagulation, fibrinolysis, inflammation and global hemostatic potential, as well as hospital outcomes including development of coagulopathy, infection, venous thromboembolism, multiple organ failure, total transfusion requirements, and mortality.

The Joint Warfighter Medical Research Program is a program of the Department of Defense Peer Reviewed Medical Research Program (PRMRP). Funding for this program is directed by Congress to “augment and accelerate high priority Department of Defense and Service medical requirements and to continue prior year initiatives that are close to achieving their objectives and yielding a benefit to military medicine.”

Female Sex Hormone May Increase Survival Time Following Massive Blood Loss

Thursday, October 22nd, 2015

After years of research showing promise that a female sex hormone may prolong survival despite massive loss of blood, University of Alabama at Birmingham researchers received funding from the Combat Casualty Care Research Program, US Army Medical Research and Materiel Command, to conduct human trials.

Irshad Chaudry, Ph.D, and colleagues at UAB discovered, after accidentally receiving female rats for study, that “a dose of the estrogen 17β-estradiol (E2) could protect males and females against septicemia…The estrogen affects the immune system and cardiovascular responses, which typically are profoundly depressed after trauma.”

In follow-on studies, Chaudry and his colleagues found that E2 could allow survival for three hours without any fluid resuscitation, and long-term survival if fluid resuscitation was provided after three hours.

Chaudry’s 19-year study of the effect of estrogen began at the Shock and Trauma laboratories, Michigan State University, and at the Center for Surgical Research at Brown University School of Medicine. Chaudry moved to UAB in 2000.

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NTI Is Awarded $4.6M Contract for Repository and Military-Relevant Research

Wednesday, October 7th, 2015

Research Repository Fact SheetThe National Trauma Institute today announced the award of a $4.6 million Department of Defense Extramural Medical Research grant to develop a National Trauma Research Repository (NTRR) and fund three promising studies with both military and civilian trauma care implications, whose results will be the first to populate the repository.

“Collaboration between military treatment centers and civilian trauma research centers that focuses on combat casualty research priorities is critical to advancing patient care in both military and civilian contexts,” said NTI’s Executive Director Sharon Smith. “With this contract, the DOD is keeping the country’s wounded soldiers as its highest priority by enabling highly qualified civilian trauma centers to continue and add to the work conducted within its Combat Casualty Care Research Program.”

The grant will fund multi-center studies aimed at some significant knowledge gaps, including an evaluation of Ketamine as an alternative to narcotics in treating severe pain following traumatic injury; development of a surgical airway training system to help combat medics, EMT-paramedics, emergency physicians and surgeons develop surgical competency; and a study of a variety of therapies for mitigating vascular trauma injury that results in non-compressible hemorrhage, the leading cause of death on the modern battlefield.

A follow-on to earlier NTI work, a National Trauma Research Repository will enable the synthesis of these and other study data for maximum use. “Because clinical trauma research has largely been accomplished through disconnected efforts, too often these efforts see delays and duplications, inefficiencies and increased costs,” said Dr. Donald Jenkins, the Mayo Clinic’s Director of Trauma, NTI Board member and Principle Investigator on this project. “Among many other benefits, the NTRR will enable repurposing of data to answer additional research questions and provide for pooled data sets with the statistical power necessary to improve statistical significance.

“The ability to make aggregated research data widely available to clinical investigators is critical to reform trauma research and care,” added Jenkins. “While the practice of medicine should be evidence-based, within the field of trauma there is surprisingly little evidence to support clinical practice. A research data repository will ensure maximum utilization of trauma data for translation into evidence-based practice.”

Learn more about the benefits of research repositories.

 

 

Cutting Transport Time and Enhancing Pre-Hospital Care Saved Hundreds

Monday, October 5th, 2015

Sept 30, 2015 JAMA articleIn the September 30, 2015 online edition of JAMA Surgery, Russ S. Kotwal, MD, et al. review the effect of a 2009 policy change on the morbidity and mortality of combat casualties in the wars in Iraq and Afghanistan. Then Secretary of Defense, Robert Gates, issued a mandate to reduce transport time from battlefield to hospital care to 60 minutes—the so called “golden hour.”

According to the researchers, transport time was reduced by 52% to a mean of 73 minutes, and the study “…showed a significant survival benefit after the mandate, specifically as a result of a reduction in KIA [killed in action] mortality.” This decrease persisted despite an increase in the severity of injuries being treated as method of injury shifted from gunshots to explosions as the wars progressed.

Despite acknowledged limitations of the study, the authors note, “the data show that…shorter transport times and enhancements to treatment capability…improved outcomes and potentially saved 359 lives.”

In his invited commentary on the study, “The Power of Advanced Capability and Informed Policy,” Col Todd E. Rasmussen, MD, Director of the US Combat Casualty Care Research Program, notes that reduction in the KIA percentage following the policy change provides evidence of an enhanced capability during the golden hour after injury that includes enhanced point of injury care and en route platforms, in addition to the reduction in transport time.

Rasmussen cautions against a “mission-complete” reaction, however, suggesting that future casualty care scenarios may be more complex and that military and civilian planners should “learn from the whole of the effort…and develop better ways to build trauma care capability and inform policy for future, more complex casualty scenarios.”

Read the article and commentary