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

Edward P. Sloan, Max Koenigsberg, W. Brad Weir, James M. Clark, Robert O'Connor, Michael Olinger, Rita Cydulka

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)54-61
Number of pages8
JournalPrehospital and Disaster Medicine
Volume30
Issue number1
StatePublished - Feb 1 2015

Fingerprint

Resuscitation
Emergencies
Clinical Trials
Hospital Emergency Service
Wounds and Injuries
Emergency Medical Services
Glasgow Coma Scale
Operating Rooms
Intubation
Hemorrhagic Shock
diaspirin-cross-linked hemoglobin
Blood Volume
Blood Transfusion
Traumatic Shock
Succinylcholine
Injury Severity Score
Airway Management
Trauma Centers
Midazolam
Hemoglobins

Keywords

  • DCLHb diaspirin cross-linked hemoglobin
  • ED emergency department
  • EMS Emergency Medical Services
  • ETI endotracheal intubation
  • GCS Glasgow Coma Scale
  • HR heart rate
  • ISS injury severity score
  • IV intravenous
  • MOI mechanism of injury
  • OR operating room
  • PRBC packed red blood cell
  • RR respiratory rate
  • RSI rapid sequence intubation
  • RTS revised trauma score
  • SBC systolic blood pressure
  • T-RTS triage revised trauma score
  • TBI traumatic brain injury
  • wounds and injuries

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Sloan, E. P., Koenigsberg, M., Weir, W. B., Clark, J. M., O'Connor, R., Olinger, M., & Cydulka, R. (2015). Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial. Prehospital and Disaster Medicine, 30(1), 54-61.

Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial. / Sloan, Edward P.; Koenigsberg, Max; Weir, W. Brad; Clark, James M.; O'Connor, Robert; Olinger, Michael; Cydulka, Rita.

In: Prehospital and Disaster Medicine, Vol. 30, No. 1, 01.02.2015, p. 54-61.

Research output: Contribution to journalArticle

Sloan, EP, Koenigsberg, M, Weir, WB, Clark, JM, O'Connor, R, Olinger, M & Cydulka, R 2015, 'Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial', Prehospital and Disaster Medicine, vol. 30, no. 1, pp. 54-61.
Sloan, Edward P. ; Koenigsberg, Max ; Weir, W. Brad ; Clark, James M. ; O'Connor, Robert ; Olinger, Michael ; Cydulka, Rita. / Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial. In: Prehospital and Disaster Medicine. 2015 ; Vol. 30, No. 1. pp. 54-61.
@article{e687931dedec4f988ef957fd574353dc,
title = "Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial",
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.",
keywords = "DCLHb diaspirin cross-linked hemoglobin, ED emergency department, EMS Emergency Medical Services, ETI endotracheal intubation, GCS Glasgow Coma Scale, HR heart rate, ISS injury severity score, IV intravenous, MOI mechanism of injury, OR operating room, PRBC packed red blood cell, RR respiratory rate, RSI rapid sequence intubation, RTS revised trauma score, SBC systolic blood pressure, T-RTS triage revised trauma score, TBI traumatic brain injury, wounds and injuries",
author = "Sloan, {Edward P.} and Max Koenigsberg and Weir, {W. Brad} and Clark, {James M.} and Robert O'Connor and Michael Olinger and Rita Cydulka",
year = "2015",
month = "2",
day = "1",
language = "English (US)",
volume = "30",
pages = "54--61",
journal = "Prehospital and Disaster Medicine",
issn = "1049-023X",
publisher = "World Association for Disaster and Emergency Medicine",
number = "1",

}

TY - JOUR

T1 - Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial

AU - Sloan, Edward P.

AU - Koenigsberg, Max

AU - Weir, W. Brad

AU - Clark, James M.

AU - O'Connor, Robert

AU - Olinger, Michael

AU - Cydulka, Rita

PY - 2015/2/1

Y1 - 2015/2/1

N2 - 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.

AB - 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.

KW - DCLHb diaspirin cross-linked hemoglobin

KW - ED emergency department

KW - EMS Emergency Medical Services

KW - ETI endotracheal intubation

KW - GCS Glasgow Coma Scale

KW - HR heart rate

KW - ISS injury severity score

KW - IV intravenous

KW - MOI mechanism of injury

KW - OR operating room

KW - PRBC packed red blood cell

KW - RR respiratory rate

KW - RSI rapid sequence intubation

KW - RTS revised trauma score

KW - SBC systolic blood pressure

KW - T-RTS triage revised trauma score

KW - TBI traumatic brain injury

KW - wounds and injuries

UR - http://www.scopus.com/inward/record.url?scp=85027934340&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027934340&partnerID=8YFLogxK

M3 - Article

C2 - 25499006

AN - SCOPUS:85027934340

VL - 30

SP - 54

EP - 61

JO - Prehospital and Disaster Medicine

JF - Prehospital and Disaster Medicine

SN - 1049-023X

IS - 1

ER -