Spring 07 front cover - United States Special Operations Command

Early Versus Late Recombinant Factor VIIa in Combat Trauma PatientsRequiring Massive TransfusionPerkins, Jeremy G. MD; Schreiber, Martin A. MD; Wade, Charles E. PhD; Holcomb, John B. MDJournal of Trauma-Injury Infection & Critical Care. 62(5):1095-1101, May 2007.ABSTRACTBackground: Coagulopathy is a consequence of severe trauma, especially in massively transfused patients(>=10 units of red blood cells in 24 hours), and is associated with increased mortality. We hypothesized that recombinantfactor VIIa (rFVIIa) administered to massive transfusion patients before transfusion of 8 units of blood(early) would reduce transfusion requirements compared with rFVIIa after 8 units (late). Methods: We retrospectivelyreviewed records for trauma admissions to combat support hospitals in Iraq between January 2004 and October2005. Patients requiring a massive transfusion and receiving rFVIIa were identified. Groups were divided intothose who received rFVIIa early or late. Results: Of 5,334 trauma patients (civilian and military), 365 (6.8%) requiredmassive transfusion. Of these, 117 (32%) received rFVIIa. Complete records for blood transfusions wereavailable for 61 patients: 90% had penetrating trauma, 17 received rFVIIa early, and 44 received it late. At admission,temperature, heart rate, blood pressure, Glasgow Coma Scale score, base deficit, hemoglobin, platelets, prothrombintime/International Normalized Ratio, and Injury Severity Score were similar in both groups as wereadministered units of fresh frozen plasma, fresh whole blood, cryoprecipitate (cryo), and crystalloid. The earlyrFVIIa group required fewer units of blood during the first 24-hour period (mean 20.6 vs. 25.7, p = 0.048) and fewerunits of stored red blood cells (mean 16.7 vs. 21.7, p = 0.049). Early and late mortality (33.3% vs. 34.2%, p = NS),acute respiratory distress syndrome (5.9 vs. 6.8%, p = NS), infection (5.9% vs. 9.1%, p = NS), and thrombotic events(0% vs. 2.3%, p = NS) were similar. Conclusions: Early administration of rFVIIa decreased red blood cell use by20% in trauma patients requiring massive transfusion.How Dangerous is BASE Jumping? An Analysis of Adverse Events in 20,850 JumpsFrom the Kjerag Massif, NorwaySoreide, Kjetil MD; Ellingsen, Christian Lycke MD; Knutson, Vibeke MScJournal of Trauma-Injury Infection & Critical Care. 62(5):1113-1117, May 2007.ABSTRACTBackground: Extreme sports, including BASE (building, antenna, span, earth) jumping, are rapidly increasingin popularity. Associated with risk for injuries and deaths, this activity may pose a burden on the emergencysystem. Hitherto, no reports exist on accidents and deaths associated with BASE jumping. Methods: We reviewedrecords of 20,850 BASE jumps from 1995 to 2005 at the Kjerag massif in Norway. Frequency of deaths, accidents,and involvement of helicopter and climbers in rescue are analyzed. Fatalities were scored for injury severity scores(Abbreviated Injury Scale score, Injury Severity Score, New Injury Severity Score) on autopsy. Results: During an11-year period, a total of 20,850 jumps (median, 1,959; range, 400-3,000) resulted in 9 fatal (0.04% of all jumps; 1in every 2,317 jumps) and 82 nonfatal accidents (0.4% of all jumps; 1 in every 254 jumps). Accidents increased withthe number of jumps (r = 0.66; p = 0.007), but fatalities did not increase, nor did activation of helicopter or climbersin rescue (p > 0.05). Helicopter activation (in one-third of accidents) in rescue correlated with number of accidents(r = 0.76, p = 0.007), but not climbers. Postmortem examination (n = 7) of fatalities revealed multiple, severe injuries(Abbreviated Injury Scale score >=3) sustained in several body regions (median, Injury Severity Score 75;range, 23-75). Most nonfatal accidents were related to ankle sprains/fracture, minor head concussion, or a bruisedknee. Conclusion: BASE jumping appears to hold a five- to eightfold increased risk of injury or death comparedwith that of skydiving. The number of accidents and helicopter activation increases with the annual number ofjumps. Further analysis into the injury severity spectrum and associated hospital burden is required.Abstracts From Current Literature83