A5023794092- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Trauma and Emergency Care Studies
- Cardiac Arrest and Resuscitation
- Blood transfusion and management
- Traumatic Brain Injury and Neurovascular Disturbances
- Venous Thromboembolism Diagnosis and Management
- Sepsis Diagnosis and Treatment
- Blood donation and transfusion practices
- Acute Myocardial Infarction Research
- Hemostasis and retained surgical items
- Abdominal Trauma and Injuries
- Alcohol Consumption and Health Effects
- Thermal Regulation in Medicine
- Metabolism and Genetic Disorders
- Climate Change and Health Impacts
- Hemodynamic Monitoring and Therapy
- COVID-19 Clinical Research Studies
- Antiplatelet Therapy and Cardiovascular Diseases
- Heparin-Induced Thrombocytopenia and Thrombosis
- Healthcare cost, quality, practices
- Proteoglycans and glycosaminoglycans research
- Renal function and acid-base balance
- Heme Oxygenase-1 and Carbon Monoxide
- Maternal and fetal healthcare
- Palliative Care and End-of-Life Issues
Denver Health Medical Center
2012-2023
University of Colorado Denver
2013-2023
Denver School of Nursing
2013-2023
National Institutes of Health
2015-2022
University of Miami
2022
Hospital Israelita Albert Einstein
2022
University of Colorado Anschutz Medical Campus
2020-2022
National Heart Lung and Blood Institute
2022
Vitalant
2021
National Institute of General Medical Sciences
2015
Massive transfusion protocols (MTPs) have become standard of care in the management bleeding injured patients, yet strategies to guide them vary widely. We conducted a pragmatic, randomized clinical trial (RCT) test hypothesis that an MTP goal directed by viscoelastic assay thrombelastography (TEG) improves survival compared with guided conventional coagulation assays (CCA).This RCT enrolled patients from academic level-1 trauma center meeting criteria for activation. Upon activation, were...
Both military and civilian clinical practice guidelines include early plasma transfusion to achieve a red cell ratio approaching 1:1 1:2. However, it was not known how should be given for optimal benefit. Two recent randomized trials were published, with apparently contradictory results. The Prehospital Air Medical Plasma (PAMPer) trial showed nearly 30% reduction in mortality the prehospital environment, while Control of Major Bleeding After Trauma (COMBAT) no survival improvement.To...
BACKGROUND Trauma-induced coagulopathy (TIC) is associated with a fourfold increased risk of mortality. Hyperfibrinolysis component TIC, but its mechanism poorly understood. Plasminogen activation inhibitor (PAI-1) degradation by activated protein C has been proposed as for deregulation the plasmin system in hemorrhagic shock, other settings ischemia, tissue plasminogen activator (tPA) shown to be elevated. We hypothesized that hyperfibrinolysis TIC not result PAI-1 driven an increase tPA,...
The acute coagulopathy of trauma is present in up to one third patients by the time admission, and recent CRASH-2 MATTERs trials have focused worldwide attention on hyperfibrinolysis as a component trauma. Thromboelastography (TEG) powerful tool for analyzing fibrinolyis, but clinically relevant threshold defining has yet be determined. Recent data suggest that accepted normal upper bound 7.5% 30-minute fibrinolysis (LY30) TEG inappropriate severe trauma, risk death rises at much lower...
Thromboelastography (TEG) is emerging as the standard in management of acute coagulopathies injured patients. Although TEG sensitive detecting abnormalities clot strength, one shortcoming differentiating between fibrinogen and platelet contributions to integrity. Current American algorithms suggest transfusion, whereas European guidelines concentrates for correcting low strength. Therefore, we hypothesized that a TEG-based functional (FF) assay would assess contribution platelets strength...
Fibrinolysis shutdown (SD) is an independent risk factor for increased mortality in trauma. High levels of plasminogen activator inhibitor-1 (PAI-1) directly binding tissue (t-PA) a proposed mechanism SD; however, patients with low PAI-1 present to the hospital rapid TEG (r-TEG) LY30 suggestive SD. We therefore hypothesized that two distinct phenotypes SD exist, one, which driven by t-PA inhibition, whereas another due inadequate release response injury.
Venous thromboembolic (VTE) disease has a high incidence following trauma, but debate remains regarding optimal prophylaxis. Thrombelastography (TEG) been suggested to be in guiding Thus, we designed phase II randomized controlled trial test the hypothesis that TEG-guided prophylaxis with escalating low-molecular weight heparin (LMWH), followed by antiplatelet therapy would reduce VTE incidence.Surgical intensive care unit trauma patients (n = 50) were receive 5,000 IU of LMWH daily...
Traumatic brain injury (TBI) patients present on a spectrum from hypocoagulability to hypercoagulability, depending the complexity, severity, and time since injury. Prior studies have found unique coagulopathy associated with TBI using conventional coagulation assays such as INR; however, few assessed association of viscoelastic that comprehensively evaluate in whole blood. This study aims reevaluate TBI-specific trauma-induced arrival thrombelastography. Because tissue is high key...
Pulmonary vascular microthrombi are a proposed mechanism of COVID-19 respiratory failure. We hypothesized that early administration tissue plasminogen activator (tPA) followed by therapeutic heparin would improve pulmonary function in these patients.
BACKGROUND Postinjury hyperfibrinolysis (HF), defined as LY30 of 3% or greater on rapid thrombelastography (rTEG), is associated with high mortality and large use blood products. We observed that some cases HF are reversible patients who respond to hemostatic resuscitation; however, other severe seem be these patients' inevitable demise. therefore sought define this unsurvivable subtype a recognizable rTEG tracing pattern. METHODS queried our trauma registry for either died spent at least 1...
The existing evidence shows great promise for plasma as the first resuscitation fluid in both civilian and military trauma. We embarked on Control of Major Bleeding After Trauma (COMBAT) trial with support Department Defense to determine if plasma-first yields hemostatic survival benefits. methodology COMBAT study represents not only 3 years development work but also integration nearly two decades technical experience design implementation other clinical trials studies. Herein, we describe...
Venous thromboembolism (VTE) prophylaxis remains debated following trauma, and recommendations have not been established. Although hyperfibrinogenemia is a marker of proinflammatory states, it also contributes to thrombus formation. Postinjury common, but the effect on VTE has fully elucidated. Therefore, we hypothesized that heparin less effective for severe injury due hyperfibrinogenemia.In vitro studies evaluated thromboelastography (TEG) parameters in 10 healthy volunteers after addition...
Identify the metabolites that are increased in plasma of severely injured patients developed ARDS versus did not, and assay if these prime pulmonary sequestration neutrophils (PMNs) induce an animal model ARDS. We hypothesize metabolic derangement due to advanced shock critically leads PMNs, which serves as first event Summary Background Data: Intracellular accumulate patients.Untargeted metabolomics profiling 67 was completed establish a signature associated with development. Metabolites...
BACKGROUND Complement activation after trauma promotes hemostasis but is associated with increased morbidity and mortality. However, the specific pathways downstream mediators remain unclear. Recently, anaphylatoxin C4a has been shown to bind thrombin receptors. While plasma-based resuscitation modify endotheliopathy of trauma, it may provide complement zymogens that fuel ongoing inflammatory cascades. We sought characterize injury effect fresh frozen plasma (FFP) on this response....
Plasma levels of lactate and succinate are predictors mortality in critically injured patients military civilian settings. In relative terms, these metabolic derangements have been recapitulated rodent, swine, nonhuman primate models severe hemorrhage. However, no direct absolute quantitative comparison has evaluated across species.Ultra-high pressure liquid chromatography-mass spectrometry with stable isotope standards was used to determine concentrations baseline postshock rats, pigs,...
Traumatic brain injury (TBI) in combination with shock has been associated hypocoagulability. However, recent data suggest that TBI itself can promote a systemic procoagulant state via the release of brain-derived extracellular vesicles. The objective our study was to identify if differences thrombelastography indices when controlling for other variables coagulopathy following trauma. We hypothesized is independently less coagulopathic state.Prospective includes all highest-level trauma...
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving therapy for hemorrhagic shock following pelvic/lower extremity injuries in military settings. However, Zone 1 aortic (AO; above celiac artery), while providing brain/cardiac perfusion, may induce/worsen visceral ischemia and organ dysfunction. In contrast, AO 3 (below renal arteries) provides abdominal perfusion potentially minimizing ischemia/reperfusion injury. We hypothesized that, compared with...