A5090675988- Trauma and Emergency Care Studies
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Abdominal Trauma and Injuries
- Cardiac Arrest and Resuscitation
- Blood transfusion and management
- Traumatic Brain Injury and Neurovascular Disturbances
- Pelvic and Acetabular Injuries
- Abdominal Surgery and Complications
- Venous Thromboembolism Diagnosis and Management
- Sepsis Diagnosis and Treatment
- Cardiac, Anesthesia and Surgical Outcomes
- Trauma Management and Diagnosis
- Emergency and Acute Care Studies
- Blood donation and transfusion practices
- Hernia repair and management
- Intensive Care Unit Cognitive Disorders
- Autopsy Techniques and Outcomes
- Blood groups and transfusion
- Vascular Procedures and Complications
- Hemodynamic Monitoring and Therapy
- Hip and Femur Fractures
- Acute Myocardial Infarction Research
- Platelet Disorders and Treatments
- Spinal Fractures and Fixation Techniques
- Hemoglobinopathies and Related Disorders
The University of Texas Health Science Center at Houston
2016-2025
Memorial Hermann
2013-2024
Memorial Hermann–Texas Medical Center
2022-2024
Texas Medical Center
2016-2024
Cotton (United States)
2005-2023
Tripler Army Medical Center
2023
United States Army Medical Research and Development Command
2023
American College of Surgeons
2008-2022
Lakeridge Health
2022
University of Ottawa
2018-2021
<h3>Importance</h3> Severely injured patients experiencing hemorrhagic shock often require massive transfusion. Earlier transfusion with higher blood product ratios (plasma, platelets, and red cells), defined as damage control resuscitation, has been associated improved outcomes; however, there have no large multicenter clinical trials. <h3>Objective</h3> To determine the effectiveness safety of transfusing severe trauma major bleeding using plasma, cells in a 1:1:1 ratio compared 1:1:2...
To relate in-hospital mortality to early transfusion of plasma and/or platelets and time-varying plasma:red blood cell (RBC) platelet:RBC ratios.Prospective cohort study documenting the timing transfusions during active resuscitation patient outcomes. Data were analyzed using time-dependent proportional hazards models.Ten US level I trauma centers.Adult patients surviving for 30 minutes after admission who received a at least 1 unit RBCs within 6 hours (n = 1245, original group) 3 total...
Although known to be an independent predictor of poor outcomes in medical intensive care unit (ICU) patients, limited data exist regarding the prevalence and risk factors for delirium among surgical (SICU) trauma ICU (TICU) patients. The purpose this study was analyze patients.SICU TICU patients requiring mechanical ventilation (MV) >24 hours were prospectively evaluated using Richmond Agitation Sedation Scale (RASS) Confusion Assessment Method (CAM-ICU). Those with baseline dementia,...
Massive transfusion (MT) occurs in about 3% of civilian and 8% military trauma patients. Although many centers have implemented MT protocols, most do not a standardized initiation policy. The purpose this study was to validate previously described scoring systems compare these simplified nonlaboratory dependent system (Assessment Blood Consumption [ABC] score).Retrospective cohort all level I adult patients transported directly from the scene (July 2005 June 2006). Trauma-Associated Severe...
As the population ages, number of injured elderly is increasing. We sought to determine if low skeletal muscle mass adversely affected outcome in patients following trauma. Patients ≥ 65 years age with an admission abdominal computed tomography scan and requiring intensive care unit (ICU) stay at a Level I trauma center 2009–2010 were reviewed. Muscle cross-sectional area 3rd lumbar vertebra was quantified index, normalized measure mass, calculated related clinical parameters including...
Background: The importance of early and aggressive management trauma- related coagulopathy remains poorly understood. We hypothesized that a trauma exsanguination protocol (TEP) systematically provides specified numbers types blood components immediately upon initiation resuscitation would improve survival reduce overall product consumption among the most severely injured patients. Methods: recently implemented TEP, which involves immediate continued release products from bank in predefined...
Background The resuscitation of severely injured bleeding patients has evolved into a multi-modal strategy termed damage control (DCR). This guideline evaluates several aspects DCR including the role massive transfusion (MT) protocols, optimal target ratio plasma (PLAS) and platelets (PLT) to red blood cells (RBC) during DCR, recombinant activated factor VII (rVIIa) tranexamic acid (TXA). Methods Using Grading Recommendations Assessment, Development Evaluation (GRADE) methodology,...
In Brief Objective: To determine whether implementation of damage control resuscitation (DCR) in patients undergoing laparotomy (DCL) translates into improved survival. Background: DCR aims at preventing coagulopathy through permissive hypotension, limiting crystalloids and delivering higher ratios plasma platelets. Previous work has focused only on the impact (1:1:1). Methods: A retrospective cohort study was performed all DCL admitted between January 2004 August 2010. Patients were divided...
Introduction: Massive transfusion (MT) protocols have been shown to improve survival in severely injured patients. However, others noted that these higher fresh frozen plasma (FFP):red blood cell (RBC) ratios are associated with increased risk of organ failure. The purpose this study was determine whether MT failure and complications. Methods: Our institution’s exsanguination protocol (TEP) involves the immediate delivery products a 3:2 ratio RBC:FFP 5:1 for RBC:platelets. All patients...
Injury and shock lead to alterations in conventional coagulation tests (CCTs). Recently, rapid thrombelastography (r-TEG) has become recognized as a comprehensive assessment of abnormalities. We have previously shown that admission r-TEG results are available faster than CCTs predict pulmonary embolism. hypothesized r-TEGs more reliably blood component transfusion CCTs.Consecutive patients admitted between September 2009 February 2011 who met the highest-level trauma activations were...
Despite recent attention and impressive results with damage control resuscitation, the appropriate ratio of blood products to be transfused has yet defined. The purpose this study was evaluate whether suggested product ratios yield superior survival rates.After IRB approval, a retrospective evaluation performed on all trauma exsanguination protocol (TEP, n = 118) activations from February 1, 2006 July 31, 2007. A comparison cohort (pre-TEP, 140) selected admissions between August 2004...
Prediction of massive transfusion (MT) among trauma patients is difficult in the early phase management. Whole-blood thromboelastometry (ROTEM®) tests provide immediate information about coagulation status acute bleeding patients. We investigated their value for prediction MT.This retrospective study included admitted to AUVA Trauma Centre, Salzburg, Austria, with an injury severity score ≥16, from whom blood samples were taken immediately upon admission emergency room (ER). ROTEM® analyses...
Hyperfibrinolysis (HF) has been reported to occur in a range of 2% 34% trauma patients. Using rapid thromboelastography (r-TEG), we hypothesized that HF is (1) rarely present at admission on patients with severe injury and (2) associated crystalloid hemodilution. To further strengthen this hypothesis, created an vitro hemodilution model improve our mechanistic understanding the early HF.The registry was queried for who were highest-level activations admitted directly from scene (October...
American College of Surgeons Trauma Quality Improvement Best Practices recommends initial massive transfusion (MT) cooler delivery within 15 minutes protocol activation, with a goal 10 minutes. The current study sought to examine the impact timing first on patient outcomes.Patients predicted receive MT at 12 Level I trauma centers were randomized two separate ratios as described in PROPPR trial. Assessment Blood Consumption score or clinician gestalt prediction was used randomize patients...
<h3>Importance</h3> Traumatic brain injury (TBI) is the leading cause of death and disability due to trauma. Early administration tranexamic acid may benefit patients with TBI. <h3>Objective</h3> To determine whether treatment initiated in out-of-hospital setting within 2 hours improves neurologic outcome moderate or severe <h3>Design, Setting, Participants</h3> Multicenter, double-blinded, randomized clinical trial at 20 trauma centers 39 emergency medical services agencies US Canada from...
Background: Recognition of trauma-induced coagulopathy by conventional coagulation testing (CCT) is limited their slow results, incomplete characterization, and poor predictive nature. Rapid thrombelastography (r-TEG) delivers a more comprehensive assessment the system but has not been prospectively validated in trauma patients. The purpose this pilot study was to evaluate timeliness r-TEG correlation with CCTs, ability predict early blood transfusion. Methods: Over 5-month period, 583...
In Brief Objectives: To determine whether resuscitation of severely injured patients with modified whole blood (mWB) resulted in fewer overall transfusions compared component (COMP) therapy. Background: For decades, (WB) was the primary product for resuscitating hemorrhagic shock. After dramatic advances banking 1970s, donor centers began supplying hospitals individual components [red cell (RBC), plasma, platelets] and removed WB as an available product. However, no studies efficacy or...
Objective. Earlier use of plasma and red blood cells (RBCs) has been associated with improved survival in trauma patients substantial hemorrhage. We hypothesized that prehospital transfusion (PHT) thawed and/or RBCs would result patient coagulation status on admission survival. Methods. Adult records were reviewed for demographics, shock, coagulopathy, outcomes, product utilization from September 2011 to April 2013. Patients arrived by either ground or two different helicopter companies. All...
Investigate and confirm the association between sympathoadrenal activation, endotheliopathy poor outcome in trauma patients.The endotheliopathy, has only been demonstrated smaller patient cohorts animal models but needs confirmation a large independent cohort.Prospective observational study of 424 patients admitted to level 1 Trauma Center. Admission plasma levels catecholamines (adrenaline, noradrenaline) biomarkers reflecting endothelial damage (syndecan-1, thrombomodulin, sE-selectin)...
PURPOSE Following US military implementation of a cold-stored whole blood program, several trauma centers have begun incorporating uncrossmatched, group O into civilian resuscitation. We set out to evaluate the safety profile, transfusion reactions events, and impact low-titer (LTO-WB) at our center. METHODS In November 2017, we added LTO-WB each helicopters emergency department (ED) refrigerator, alongside that existing red cells plasma. collected information on all patients with receiving...
Importance Critical bleeding is associated with a high mortality rate in patients trauma. Hemorrhage exacerbated by complex derangement of coagulation, including an acute fibrinogen deficiency. Management replacement cryoprecipitate transfusions or concentrate, usually administered relatively late during hemorrhage. Objective To assess whether survival could be improved administering early and empirical dose to all trauma that required activation major hemorrhage protocol. Design, Setting,...