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Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial

Published online by Cambridge University Press:  15 December 2014

Edward P. Sloan ,
Max Koenigsberg ,
W. Brad Weir ,
James M. Clark ,
Robert O'Connor ,
Michael Olinger  and
Rita Cydulka
Edward P. Sloan*
Affiliation:
Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IllinoisUSA
Max Koenigsberg
Affiliation:
Advocate Illinois Masonic Medical Center, Chicago, IllinoisUSA
W. Brad Weir
Affiliation:
Carle Physician Group, Department of Emergency Medicine, University of Illinois College of Medicine at Urbana-Champaign, Urbana-Champaign, IllinoisUSA
James M. Clark
Affiliation:
Rush Medical College, Rush University Medical Center, Chicago, IllinoisUSA
Robert O'Connor
Affiliation:
Department of Emergency Medicine, University of Virginia, Charlottesville, VirginiaUSA
Michael Olinger
Affiliation:
Department of Emergency Medicine, Indiana University, Indianapolis, IndianaUSA
Rita Cydulka
Affiliation:
Department of Emergency Medicine, Case Western Reserve University, Cleveland, OhioUSA
*
Correspondence: Edward P. Sloan, MD, MPH Department of Emergency Medicine University of Illinois College of Medicine Mail Code 724 Room 471H CME 808 South Wood Street Chicago, Illinois 60612 USA E-mail [email protected]
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Abstract

Introduction

Optimal emergent management of traumatic hemorrhagic shock patients requires a better understanding of treatment provided in the prehospital/Emergency Medical Services (EMS) and emergency department (ED) settings.

Hypothesis/Problem

Described in this research are the initial clinical status, airway management, fluid and blood infusions, and time course of severely-injured hemorrhagic shock patients in the EMS and ED settings from the diaspirin cross-linked hemoglobin (DCLHb) clinical trial.

Methods

Data were analyzed from 17 US trauma centers gathered during a randomized, controlled, single-blinded efficacy trial of a hemoglobin solution (DCLHb) as add-on therapy versus standard therapy.

Results

Among the 98 randomized patients, the mean EMS Glasgow Coma Scale (GCS) was 10.6 (SD = 5.0), the mean EMS revised trauma score (RTS) was 6.3 (SD = 1.9), and the mean injury severity score (ISS) was 31 (SD = 17). Upon arrival to the ED, the GCS was 20% lower (7.8 (SD = 5.3) vs 9.7 (SD = 6.3)) and the RTS was 12% lower (5.3 (SD = 2.0) vs 6.0 (SD = 2.1)) than EMS values in blunt trauma patients (P < .001). By ED disposition, 80% of patients (78/98) were intubated. Rapid sequence intubation (RSI) was utilized in 77% (60/78), most often utilizing succinylcholine (65%) and midazolam (50%). The mean crystalloid volume infused was 4.2 L (SD = 3.4 L), 80% of which was infused within the ED. Emergency department blood transfusion occurred in 62% of patients, with an average transfused volume of 1.2 L (SD = 2.0 L). Blunt trauma patients received 2.1 times more total fluids (7.4 L vs 3.5 L, < .001) and 2.4 times more blood (2.4 L vs 1.0 L, P < .001). The mean time of patients taken from injury site to operating room (OR) was 113 minutes (SD = 87 minutes). Twenty-one (30%) of the 70 patients taken to the OR from the ED were sent within 60 minutes of the estimated injury time. Penetrating trauma patients were taken to the OR 52% sooner than blunt trauma patients (72 minutes vs 149 minutes, P < .001).

Conclusion

Both GCS and RTS decreased prior to ED arrival in blunt trauma patients. Intubation was performed using RSI, and crystalloid infusion of three times the estimated blood loss volume (L) and blood transfusion of the estimated blood loss volume (L) were provided in the EMS and ED settings. Surgical intervention for these trauma patients most often occurred more than one hour from the time of injury. Penetrating trauma patients received surgical intervention more rapidly than those with a blunt trauma mechanism.

SloanEP, KoenigsbergM, WeirWB, ClarkJM, O'ConnorR, OlingerM, CydulkaR. Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial. Prehosp Disaster Med. 2015;30(1):1-8.

Keywords

diaspirin cross-linked hemoglobin (DCLHb)Emergency Medical Serviceshemorrhagic shockresuscitationwounds and injuries
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 1 , February 2015 , pp. 54 - 61
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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Footnotes

Conflicts of interest: none

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