User login
Credit: UAB Hospital
A change in transfusion protocol has resulted in fewer potentially preventable deaths among soldiers, researchers have reported in JAMA Surgery.
In 2006, hospitals treating soldiers from Iraq and Afghanistan implemented a protocol called damage control resuscitation (DCR).
It involves administering blood products early and in a balanced ratio, using an aggressive approach to correct coagulopathy, and minimizing the use of crystalloid fluids.
The research showed that soldiers who died in the hospital after DCR was implemented were more likely than their predecessors to be severely injured and have a severe brain injury.
And this is consistent with a decrease in potentially preventable deaths, according to study author Nicholas R. Langan, MD, of the Madigan Army Medical Center in Tacoma, Washington, and his colleagues.
To conduct the study, the researchers reviewed data from the Joint Theater Trauma Registry of US forward combat hospitals. This included 57,179 soldiers, 2565 (4.5%) of whom died in the hospital. Seventy-four percent of these patients were severely injured, and 80% died within 24 hours of admission.
To assess the impact of DCR, the researchers divided patients into 2 groups: those treated before DCR implementation, from 2002 through 2005, and those treated with the DCR protocol, from 2006 through 2011.
The analysis showed that DCR policies were successfully implemented. There was a significant decrease in mean crystalloid infusion volume in the first 24 hours after hospitalization, from 6.1 L to 3.2 L (P<0.05).
There was a significant increase in fresh-frozen plasma use—from 3.2 U to 10.1 U (P=0.01)—and packed red blood cell use—from 8.4 U to 11.4 U (P=0.01)—in the first 24 hours after hospitalization.
And the mean ratio of packed red blood cells to fresh-frozen plasma changed from 2.6:1 in the pre-DCR period to 1.4:1 during the DCR period (P<0.01).
On the other hand, there was no significant difference in cryoprecipitate use, platelet use, or the ratio of packed red blood cells to cryoprecipitate or platelets.
The change in treatment protocol was associated with a change in the incidence of early and late, but not intermediate, deaths. The incidence of early death (within the first 24 hours) increased from 77% pre-DCR to 80% during DCR (P=0.02).
The incidence of late death (more than 7 days after injury) decreased from 10% pre-DCR to 6% during DCR (P<0.01). And the rate of intermediate death (1-7 days after injury) measured 13% for both periods (P=0.95).
The percentage of patients with any severe injury increased significantly from the pre-DCR period to the DCR period, from 64% to 80% (P<0.05). And the percentage of patients with severe head injuries increased significantly, from 57% to 73% (P<0.05).
As patients who died during the DCR period were more likely to have such “nonsurvivable” wounds, the researchers said this suggests that DCR is associated with a decrease in deaths among potentially salvageable patients. 
Credit: UAB Hospital
A change in transfusion protocol has resulted in fewer potentially preventable deaths among soldiers, researchers have reported in JAMA Surgery.
In 2006, hospitals treating soldiers from Iraq and Afghanistan implemented a protocol called damage control resuscitation (DCR).
It involves administering blood products early and in a balanced ratio, using an aggressive approach to correct coagulopathy, and minimizing the use of crystalloid fluids.
The research showed that soldiers who died in the hospital after DCR was implemented were more likely than their predecessors to be severely injured and have a severe brain injury.
And this is consistent with a decrease in potentially preventable deaths, according to study author Nicholas R. Langan, MD, of the Madigan Army Medical Center in Tacoma, Washington, and his colleagues.
To conduct the study, the researchers reviewed data from the Joint Theater Trauma Registry of US forward combat hospitals. This included 57,179 soldiers, 2565 (4.5%) of whom died in the hospital. Seventy-four percent of these patients were severely injured, and 80% died within 24 hours of admission.
To assess the impact of DCR, the researchers divided patients into 2 groups: those treated before DCR implementation, from 2002 through 2005, and those treated with the DCR protocol, from 2006 through 2011.
The analysis showed that DCR policies were successfully implemented. There was a significant decrease in mean crystalloid infusion volume in the first 24 hours after hospitalization, from 6.1 L to 3.2 L (P<0.05).
There was a significant increase in fresh-frozen plasma use—from 3.2 U to 10.1 U (P=0.01)—and packed red blood cell use—from 8.4 U to 11.4 U (P=0.01)—in the first 24 hours after hospitalization.
And the mean ratio of packed red blood cells to fresh-frozen plasma changed from 2.6:1 in the pre-DCR period to 1.4:1 during the DCR period (P<0.01).
On the other hand, there was no significant difference in cryoprecipitate use, platelet use, or the ratio of packed red blood cells to cryoprecipitate or platelets.
The change in treatment protocol was associated with a change in the incidence of early and late, but not intermediate, deaths. The incidence of early death (within the first 24 hours) increased from 77% pre-DCR to 80% during DCR (P=0.02).
The incidence of late death (more than 7 days after injury) decreased from 10% pre-DCR to 6% during DCR (P<0.01). And the rate of intermediate death (1-7 days after injury) measured 13% for both periods (P=0.95).
The percentage of patients with any severe injury increased significantly from the pre-DCR period to the DCR period, from 64% to 80% (P<0.05). And the percentage of patients with severe head injuries increased significantly, from 57% to 73% (P<0.05).
As patients who died during the DCR period were more likely to have such “nonsurvivable” wounds, the researchers said this suggests that DCR is associated with a decrease in deaths among potentially salvageable patients.
Credit: UAB Hospital
A change in transfusion protocol has resulted in fewer potentially preventable deaths among soldiers, researchers have reported in JAMA Surgery.
In 2006, hospitals treating soldiers from Iraq and Afghanistan implemented a protocol called damage control resuscitation (DCR).
It involves administering blood products early and in a balanced ratio, using an aggressive approach to correct coagulopathy, and minimizing the use of crystalloid fluids.
The research showed that soldiers who died in the hospital after DCR was implemented were more likely than their predecessors to be severely injured and have a severe brain injury.
And this is consistent with a decrease in potentially preventable deaths, according to study author Nicholas R. Langan, MD, of the Madigan Army Medical Center in Tacoma, Washington, and his colleagues.
To conduct the study, the researchers reviewed data from the Joint Theater Trauma Registry of US forward combat hospitals. This included 57,179 soldiers, 2565 (4.5%) of whom died in the hospital. Seventy-four percent of these patients were severely injured, and 80% died within 24 hours of admission.
To assess the impact of DCR, the researchers divided patients into 2 groups: those treated before DCR implementation, from 2002 through 2005, and those treated with the DCR protocol, from 2006 through 2011.
The analysis showed that DCR policies were successfully implemented. There was a significant decrease in mean crystalloid infusion volume in the first 24 hours after hospitalization, from 6.1 L to 3.2 L (P<0.05).
There was a significant increase in fresh-frozen plasma use—from 3.2 U to 10.1 U (P=0.01)—and packed red blood cell use—from 8.4 U to 11.4 U (P=0.01)—in the first 24 hours after hospitalization.
And the mean ratio of packed red blood cells to fresh-frozen plasma changed from 2.6:1 in the pre-DCR period to 1.4:1 during the DCR period (P<0.01).
On the other hand, there was no significant difference in cryoprecipitate use, platelet use, or the ratio of packed red blood cells to cryoprecipitate or platelets.
The change in treatment protocol was associated with a change in the incidence of early and late, but not intermediate, deaths. The incidence of early death (within the first 24 hours) increased from 77% pre-DCR to 80% during DCR (P=0.02).
The incidence of late death (more than 7 days after injury) decreased from 10% pre-DCR to 6% during DCR (P<0.01). And the rate of intermediate death (1-7 days after injury) measured 13% for both periods (P=0.95).
The percentage of patients with any severe injury increased significantly from the pre-DCR period to the DCR period, from 64% to 80% (P<0.05). And the percentage of patients with severe head injuries increased significantly, from 57% to 73% (P<0.05).
As patients who died during the DCR period were more likely to have such “nonsurvivable” wounds, the researchers said this suggests that DCR is associated with a decrease in deaths among potentially salvageable patients.