Summer - United States Special Operations Command

tourniquet times are less than 6 hours. Hypothesis: We hypothesized that prehospital tourniquet use decreasedhemorrhage from extremity injuries and saved lives, and was not associated with a substantial increase in adverselimb outcomes. Methods: This was an institutional review board-approved, retrospective review of the 31stcombat support hospital for 1 year during Operation Iraqi Freedom. Inclusion criteria were any patient with atraumatic amputation, major extremity vascular injury, or documented prehospital tourniquet. Results: Among3,444 total admissions, 165 patients met inclusion criteria. Sixty-seven patients had prehospital tourniquets(TK); 98 patients had severe extremity injuries but no prehospital tourniquet (No TK). Extremity Acute InjuryScores were the same (3.5 TK vs. 3.4 No TK) in both groups. Differences (p < 0.05) were noted in the numbersof patients with arm injuries (16.2% TK vs. 30.6% No TK), injuries requiring vascular reconstruction (29.9% TKvs. 52.5% No TK), traumatic amputations (41.8% TK vs. 26.3% No TK), and in those patients with adequatebleeding control on arrival (83% TK vs. 60% No TK). Secondary amputation rates (4 (6.0%) TK vs. 9 (9.1%)No TK); and mortality (3 (4.4%) TK vs. 4 (4.1%) No TK) did not differ. Tourniquet use was not deemed responsiblefor subsequent amputation in severely mangled extremities. Analysis revealed that four of seven deathswere potentially preventable with functional prehospital tourniquet placement. Conclusions: Prehospital tourniquetuse was associated with improved hemorrhage control, particularly in the worse injured (Injury SeverityScore >15) subset of patients. Fifty-seven percent of the deaths might have been prevented by earlier tourniquetuse. There were no early adverse outcomes related to tourniquet use.Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients WithCombat Related Traumatic InjuriesSpinella, Philip C. MD; Perkins, Jeremy G. MD; Grathwohl, Kurt W. MD; Beekley, Alec C. MD; Niles, SarahE. MD, MPH; McLaughlin, Daniel F. MD; Wade, Charles E. PhD; Holcomb, John B. MCJournal of Trauma-Injury Infection & Critical Care. Advances in Combat Casualty Care: Clinical Outcomesfrom the War. 64(2) Supplement:S69-S78, February 2008.ABSTRACTBackground: The amount and age of stored red blood cells (RBCs) are independent predictors of multiorgan failureand death in transfused critically ill patients. The independent effect of plasma transfusion on survival hasnot been evaluated. Our objective was to determine the independent effects of plasma and RBC transfusion onsurvival for patients with combat-related traumatic injuries receiving any blood products. Methods: We performeda retrospective review of 708 patients transfused at least one unit of a blood product at one combat supporthospital between November 2003 and December 2004. Admission vital signs, laboratory values, amountof blood products transfused in a 24-hour period, and Injury Severity Score (ISS) were analyzed by multivariatelogistic regression to determine independent associations with in-hospital mortality. Results: Seven hundredand eight of 3,287 (22%) patients admitted for traumatic injuries were transfused a blood product. Median ISSwas 14 (range, 9-25). In-hospital mortality was 12%. Survival was associated with admission Glasgow ComaScale score, SBP, temperature, hematocrit, base deficit, INR, amount of RBCs transfused, and massive transfusion.Each transfused FFP unit was independently associated with increased survival (OR: 1.17; 95% CI: [1.06-1.29]; p = 0.002); each transfused RBC unit was independently associated with decreased survival (OR: 0.86;[0.8-0.92]; p = 0.001). A subset analysis of patients (n = 567) without massive transfusion (1-9 RBC/FWB units)also revealed an independent association between each FFP unit and improved survival (OR: 1.22; 95% CI: [1.0-1.48]; p = 0.05) and between each RBC unit and decreased survival (OR: 0.77; [0.64-0.92]; p = 0.004). Conclusion:For trauma patients transfused at least one unit of a blood product, FFP and RBC amounts wereindependently associated with increased survival and decreased survival, respectively. Prospective studies areneeded to determine whether the early and increased use of plasma and decreased use of RBCs affect mortalityfor patients with traumatic injuries requiring transfusion.Abstracts From Current Literature53