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Damage Control Resuscitation


MISSION

The mission of the Damage Control Resuscitation task area is to identify solutions to deficits associated with the control of bleeding and the stabilization of injured Soldiers, with the emphasis on treatments far forward of fixed medical facilities.

Damage Control Resuscitation Major Accomplishments

2004: Army Top 10 Greatest Invention for HemCon hemostatic dressing

2005: Army Top 10 Greatest Invention for the Combat Tourniquet

2006: Department of Army Research and Development Achievement Award for Hypotensive Resuscitation

2007: Army Top 10 Greatest Invention for Damage Control Resuscitation

2008: ATACCC Award for Combat Gauze

2008: Army Top 10 Greatest Invention for Combat Gauze hemostatic dressing

2010: ATACCC Award for Tourniquets

The goals of the program are:

1) To investigate improved methods of hemorrhage control and hemostasis

2) To develop resuscitation strategies that simultaneously restore coagulation and metabolic function and replace the intravascular volume deficit

3) To understand the involvement of complement in the inflammatory response to trauma and investigate the potential benefit of complement inhibitors

4) Investigate potential cytoprotective/tissue stabilization/immune modulation drugs as small volume resuscitation products


RESEARCH PRIORITIES

Hemorrhage remains the major cause of potentially preventable death on the battlefield in conventional warfare. This fact has led to significant efforts to improve the ability of first responders to limit blood loss and treat hemorrhage at the point of injury.

As a result of improved initial care, as well as rapid evacuation and positioning of surgical capabilities close to the point of injury, service members with severe injuries survive to reach field hospitals. It is known that severely injured casualties often develop a coagulopathy and metabolic disorders associated with acidosis, hypothermia and hemodilution; conditions which increase the risk of dying.

This set of disorders in casualties at the highest risk of dying is best addressed through the concept of damage control resuscitation. This includes avoiding dilution of coagulation factors via replacement with appropriate blood products (e.g., plasma) to provide these factors, providing oxygen carrying capability (Red Blood Cells), and restoring sufficient circulating volume to improve tissue perfusion and correct metabolism, without increasing the chance for rebleeding.

To address these issues, the Damage Control Resuscitation task area investigates hemostatic dressings, tourniquets and other products for hemorrhage control, more balanced hemostatic resuscitation with plasma, red blood cells, platelets and other blood components, hypothermia prevention products, drugs, including complement inhibitors for tissue stabilization and immune modulation, and genetic and epigenetic factors that relate to survival from hemorrhage.

Much of the research on blood products is closely tied to the Coagulation and Blood Research task area.


SELECTED PUBLICATIONS

1. Kheirabadi BS, MR Scherer, JS Estep, MA Dubick, JB Holcomb. Determination of efficacy of new hemostatic dressings in a model of extremity arterial hemorrhage in swine. J Trauma 67:450-459, 2009.

2. Kragh JF Jr, Littrel ML, Jones JA, Walters TJ, Baer DG, Wade CE, Holcomb JB. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 41(6):590-597, 2011.

3. Allen PB, SW Salyer, MA Dubick, JB Holcomb, LH Blackbourne. Preventing hypothermia: Comparison of current devices used By the US Army in an in Vitro warmed fluid model. J Trauma 69 (Suppl 1): S154-S161, 2010.

4. Sondeen JL, MD Prince, BS Kheirabadi, CE Wade, IA Polykratis, R de Guzman Jr, MA Dubick. Initial resuscitation with plasma and other blood components reduced bleeding compared to hextend in anesthetized swine with uncontrolled splenic hemorrhage. Transfusion 51:779-792, 2011.

5. Burns JW, LA Baer, EJ Hagerman, BS Jordan, JJ Nelson Jr, AI Batchinsky, LC Cancio, JA Jones, MA Dubick, CE Wade. Development and resuscitation of a sedated, mature male miniature swine severe hemorrhage model. J Trauma 71: 148-156, 2011.

6. Dalle Lucca JJ, Simovic M, Li Y, Moratz C, Falabella M, Tsokos GC. Decay-Accelerating Factor Mitigates Controlled Hemorrhage-Instigated Intestinal and Lung Tissue Damage and Hyperkalemia in Swine. J Trauma 7:S151-60, 2011.

7. Kheirabadi BS, F Arnaud, R McCarron, AD Murdock, DL Hodge, B Ritter, MA Dubick, LH Blackbourne. Development of a standard swine hemorrhage model for efficacy assessment of topical hemostatic agents. J Trauma 71(Suppl 1):S139-S146, 2011.

8. Klemcke HG, Joe B, Calderon ML, Rose R, Oh T, Aden J, Ryan KL. Genetic influences on survival time after severe hemorrhage in inbred rat strains. Physiol Genomics 43: 758-765, 2011.

9. Martini WZ. Fibrinogen availability and coagulation function after hemorrhage and resuscitation in pigs. Mol Med. 17(7-8):757-61, 2011.

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