1
|
Taheri BD, Fisher AD, Eisenhauer IF, April MD, Rizzo JA, Guliani SS, Flarity KM, Cripps M, Bebarta VS, Wohlauer MV, Schauer SG. The employment of resuscitative endovascular balloon occlusion of the aorta in deployed settings. Transfusion 2024. [PMID: 38581267 DOI: 10.1111/trf.17823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been often used in place of open aortic occlusion for management of hemorrhagic shock in trauma. There is a paucity of data evaluating REBOA usage in military settings. STUDY DESIGN AND METHODS We queried the Department of Defense Trauma Registry (DODTR) for all cases with at least one intervention or assessment available within the first 72 h after injury between 2007 and 2023. We used relevant procedural codes to identify the use of REBOA within the DODTR, and we used descriptive statistics to characterize its use. RESULTS We identified 17 cases of REBOA placed in combat settings from 2017 to 2019. The majority of these were placed in the operating room (76%) and in civilian patients (70%). A penetrating mechanism caused the injury in 94% of cases with predominantly the abdomen and extremities having serious injuries. All patients subsequently underwent an exploratory laparotomy after REBOA placement, with moderate numbers of patients having spleen, liver, and small bowel injuries. The majority (82%) of included patients survived to hospital discharge. DISCUSSION We describe 17 cases of REBOA within the DODTR from 2007 to 2023, adding to the limited documentation of patients undergoing REBOA in military settings. We identified patterns of injury in line with previous studies of patients undergoing REBOA in military settings. In this small sample of military casualties, we observed a high survival rate.
Collapse
Affiliation(s)
- Branson D Taheri
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Air Education and Training Command, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio, USA
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Texas Army National Guard, Austin, Texas, USA
| | - Ian F Eisenhauer
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, Denver Health, Denver, Colorado, USA
- Navy Medicine Leader and Professional Development Command, Bethesda, Maryland, USA
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- 14th Field Hospital, Fort Stewart, Georgia, USA
| | - Julie A Rizzo
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Brooke Army Medical Center, JBSA, Fort Sam Houston, Texas, USA
| | - Sundeep S Guliani
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Kathleen M Flarity
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael Cripps
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vikhyat S Bebarta
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Max V Wohlauer
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven G Schauer
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
2
|
Eisenhauer IF, Walrath BD, Bebarta VS, Tadlock MD, Baker JB, Schauer SG. Navy En-Route Care in future Distributed Maritime Operations: A review of clinician capabilities and roles of care. PREHOSP EMERG CARE 2022; 27:465-472. [PMID: 35914100 DOI: 10.1080/10903127.2022.2107127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE As the United States Navy transitions from Operation Iraqi Freedom/Operation Enduring Freedom to preparing for a near-peer competition, an increasing focus of wartime strategy relies upon a network of distributed naval assets for total sea control, known as Distributed Maritime Operations (DMO). Historically, embedded medical personnel have provided care at sea in times of war. Recent reviews of shipboard and evacuated mass casualty incidents have alluded to weaknesses in the existing Navy Medicine approach that will require advances in care provision to sustain high-quality care that would benefit from industry and civilian academic collaboration. To gain input from civilian prehospital expertise and insight, the current DMO and Navy En-Route Care (ERC) systems must be plainly described for non-Navy military and civilian leaders, clinicians, and researchers to understand (1). METHODS N/AResults: In this review, we translate US Navy structure and vernacular into common civilian and non-Navy language, describe the maritime role-tiered ERC system, elucidate the medical assets on each naval warship, and discuss clinician levels and capabilities while deployed to help communicate the inherent challenges of US Navy maritime medical care during routine operations, casualty treatment, stabilization, and evacuation. CONCLUSIONS We describe the roles of care, clinician levels, and medical assets within the Navy ERC system for researchers and military leaders who aim to mitigate the inherent challenges of future maritime trauma care in the age of Distributed Maritime Operations. This paper lays the framework for the Navy deployed medical system to enable research in maritime en-route care, and prompt inclusion of identified solutions into common use in the US Navy.
Collapse
Affiliation(s)
- Ian F Eisenhauer
- Denver Health Department of Emergency Medicine, Denver, Colorado, USA.,University of Colorado Anschutz Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, CO, USA
| | | | - Vikhyat S Bebarta
- University of Colorado Anschutz Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, CO, USA.,Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Jay B Baker
- Joint Trauma System, JBSA Fort Sam Houston,San Antonio, TX, USA.,Brooke Army Medical Center, JBSA Fort Sam Houston,San Antonio, TX, USA
| | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston,San Antonio, TX, USA.,US Army Institute of Surgical Research, JBSA Fort Sam Houston,San Antonio, TX, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
3
|
Eisenhauer IF, Hoover CM, Remais JV, Monaghan A, Celada M, Carlton EJ. Estimating the Risk of Domestic Water Source Contamination Following Precipitation Events. Am J Trop Med Hyg 2016; 94:1403-6. [PMID: 27114298 DOI: 10.4269/ajtmh.15-0600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/08/2016] [Indexed: 11/07/2022] Open
Abstract
Climate change is expected to increase precipitation extremes, threatening water quality. In low resource settings, it is unclear which water sources are most vulnerable to contamination following rainfall events. We evaluated the relationship between rainfall and drinking water quality in southwest Guatemala where heavy rainfall is frequent and access to safe water is limited. We surveyed 59 shallow household wells, measured precipitation, and calculated simple hydrological variables. We compared Escherichia coli concentration at wells where recent rainfall had occurred versus had not occurred, and evaluated variability in the association between rainfall and E. coli concentration under different conditions using interaction models. Rainfall in the past 24 hours was associated with greater E. coli concentrations, with the strongest association between rainfall and fecal contamination at wells where pigs were nearby. Because of the small sample size, these findings should be considered preliminary, but provide a model to evaluate vulnerability to climate change.
Collapse
Affiliation(s)
- Ian F Eisenhauer
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California; National Center for Atmospheric Research, Boulder, Colorado; Centro de Desarrollo Humano, Trifinio, Guatemala; Center for Global Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Christopher M Hoover
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California; National Center for Atmospheric Research, Boulder, Colorado; Centro de Desarrollo Humano, Trifinio, Guatemala; Center for Global Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Justin V Remais
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California; National Center for Atmospheric Research, Boulder, Colorado; Centro de Desarrollo Humano, Trifinio, Guatemala; Center for Global Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Andrew Monaghan
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California; National Center for Atmospheric Research, Boulder, Colorado; Centro de Desarrollo Humano, Trifinio, Guatemala; Center for Global Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Marco Celada
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California; National Center for Atmospheric Research, Boulder, Colorado; Centro de Desarrollo Humano, Trifinio, Guatemala; Center for Global Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Elizabeth J Carlton
- School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California; National Center for Atmospheric Research, Boulder, Colorado; Centro de Desarrollo Humano, Trifinio, Guatemala; Center for Global Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|