Campbell A, Rubsamen M, Adkins R
… +9 more, Sparling K, Brown E, Tatum D, Harrell K, Zhang J, McGinness C, Shammassian B, Taghavi S, New Orleans, Louisiana
J Trauma Acute Care Surg
· 2026 Mar · PMID 41860430
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Vattipally VN, Dewan A, Jillala RR
… +11 more, Aude CA, Kramer P, Jo J, Hughes LP, Khalifeh JM, Lubelski D, Bydon A, Witham TF, Theodore N, Azad TD, Baltimore, Maryland
J Trauma Acute Care Surg
· 2026 Jun · PMID 41860348
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Lackie M, Amberman K, Patterson K
… +16 more, Mares J, Hutzler J, Tiwari N, Killingsworth Z, Snowden D, Green JT, Do W, Morrison J, Powell E, Radowsky J, Propper B, Haigney M, Bradley M, Burmeister D, Walker P, Bethesda, Maryland
J Trauma Acute Care Surg
· 2026 Jun · PMID 41849574
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BACKGROUND: Exsanguination cardiac arrest (ECA) remains a formidable challenge in trauma surgery with a persistently dismal prognosis. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown promise in medical card...BACKGROUND: Exsanguination cardiac arrest (ECA) remains a formidable challenge in trauma surgery with a persistently dismal prognosis. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown promise in medical cardiac arrest and may translate to trauma. We hypothesized that aortic cardiopulmonary resuscitation in trauma (ACT)-a controlled ECPR approach aimed at mitigating reperfusion injury-would improve sustained return of spontaneous circulation (ROSC) compared with resuscitative thoracotomy (RT) in a porcine ECA model. METHODS: Twelve swine were bled to mean arterial pressure <20 mm Hg and end-tidal CO 2 <10 mm Hg for 1 minute, defining ECA. After 10 minutes of ECA, animals received one of two pre-assigned interventions: (1) control with RT, aortic cross-clamp, open cardiac massage, intravenous whole blood transfusion, and 100% FiO 2 (n=6) or (2) ACT, involving venoarterial extracorporeal membrane oxygenation (VA-ECMO) with graded FiO 2 advancement and passive hypothermia (n=6). Both groups received a 30-minute resuscitation phase followed by a 90-minute critical care phase. The primary endpoint was ROSC-defined as mean arterial pressure >50 mm Hg with a sinus rhythm-at the end of the critical care period. Secondary outcomes included coronary and carotid flow to assess critical organ perfusion during resuscitation. RESULTS: The primary endpoint was achieved in 100% of ACT animals versus 0% of controls ( p <0.001). All subjects showed pulseless electrical activity during ECA; 6/6 controls developed ventricular fibrillation during resuscitation compared with 2/6 in ACT ( p =0.060). During the critical care phase, ACT led to increased mean left-anterior-descending coronary artery flow (41.6±0.2 mL/min vs. 31.7±0.6 mL/min in RT) and right carotid artery flow (214.8±0.5 mL/min vs. 90.7±1.0 mL/min, both p <0.0001). CONCLUSIONS: Following ECA, ACT produced a markedly higher rate of sustained ROSC compared with conventional RT and significantly augmented coronary and carotid perfusion-highlighting its potential as a trauma-focused ECPR modality. LEVEL OF EVIDENCE: Preclinical-large animal model.
J Trauma Acute Care Surg
· 2026 Feb · PMID 41745139
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BACKGROUND: Readiness for large-scale combat operations (LSCOs) remains a persistent challenge for military and civilian medical providers. This study assessed physicians' self-reported confidence in delivering damage-co...BACKGROUND: Readiness for large-scale combat operations (LSCOs) remains a persistent challenge for military and civilian medical providers. This study assessed physicians' self-reported confidence in delivering damage-control resuscitation and damage-control surgery in LSCOs scenarios and identified opportunities for improvement (OFIs). METHODS: A 40-item survey was distributed to all deployable Armed Forces' physicians (active duty, residents, reservists, contractors, and civilians) with military medical training. The survey explored confidence in performing lifesaving interventions across 15 tactical and medical scenarios and collected suggested OFIs. RESULTS: Of 2,145 eligible physicians, 474 (22%) responded: 51% active duty, 21.5% residents, and 18% reservists. The median time since graduation was 7 years (interquartile range, 1-13). Among respondents, 11% reported high confidence, 18% moderate, and 71% low. Compared with the low-confidence group, high-confidence physicians were older (median age, 40.0 vs. 34.0 years; p < 0.001), more often male (86.0% vs. 51.5%, p < 0.001), and more frequently reservists (30.0% vs. 15.5%, p = 0.005). Surgeons and anesthesiologists/intensivists were overrepresented in the high-confidence group ( p < 0.001). Daily clinical activity in trauma center level 1 facilities was more common among high-confidence physicians (62.7% vs. 27.5%, p < 0.001). Multivariate analysis identified significant associations between high confidence and performing lifesaving procedures both domestically and overseas (odds ratio [OR], 1.13; p < 0.001), being an anesthesiologist (OR, 9.56; p = 0.002), and the number of years after graduation (OR, 1.05; p = 0.044). Simulation-based training was the most frequently cited OFI, followed by regular clinical exposure in trauma centers and online interprofessional knowledge exchange. Key training needs identified included crew resource management, prolonged casualty care, and multiple-organ failure management. CONCLUSION: Confidence in damage-control resuscitation and damage-control surgery delivery during LSCOs remains limited. Structured, experiential, and specialty-specific training is essential to improve preparedness in deployed medical teams. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.
Meredyth N, Song J, Hatchimonji J
… +6 more, Haddad D, Cannon J, Wathen C, Howard S, Schuster J, Kaufman E
J Trauma Acute Care Surg
· 2026 Mar · PMID 41728879
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INTRODUCTION: For patients presenting with gunshots to the head and injuries to the neck or torso, head computed tomography (CT) provides essential information for prognosticating and managing brain injury but may delay...INTRODUCTION: For patients presenting with gunshots to the head and injuries to the neck or torso, head computed tomography (CT) provides essential information for prognosticating and managing brain injury but may delay hemorrhage (HRH) control. We hypothesized that use of preoperative head CT would be common, and clinicians would prioritize neuroimaging over prompt HRH control in patients with multiple penetrating injuries at high risk for HRH. METHODS: Using a statewide trauma database to identify patients who sustained gunshot wounds (2017-2021) with both penetrating brain injury and penetrating neck or torso injury, patients were characterized as high risk for HRH if they had systolic blood pressure <90 mm Hg, received ≥3 U of packed red blood cell every 4 hours, or required a massive transfusion protocol. Suspected severe traumatic brain injury was defined as Glasgow Coma Scale score of 3, or Glasgow Coma Scale score of ≤8 and abnormal pupils. We compared patient characteristics and outcomes using descriptive statistics. RESULTS: Of 1,094 patients, 428 (39.1%) were HRH. Of these, 287 (67.0%) went to CT from the trauma bay, and 91 (21.2%) went to the operating room (OR). Furthermore, 56.2% of HRH patients who went directly to the OR survived compared with 44.1% who went to CT prior to OR and 16.7% with CT only (p < 0.001). Of the 344 HRH patients (80.4%) who died, having a CT scan and no operation (25.4%) was associated with higher rates of organ donation. For the 84 HRH patients (19.6%) who survived, operative intervention was associated with better motor functional status at discharge. CONCLUSION: Patients with penetrating injury to the brain and torso often went to CT before the OR, even with high risk of HRH. Having a CT scan without any operation may result in increased organ donation, while forgoing imaging may decrease mortality and improve motor function at discharge. Decision making remains a challenge for these complex patients, but trauma surgeons should prioritize prompt intervention when feasible. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.
Yee EK, Little D, Mason SA
… +7 more, Rosella LC, Jaakkimainen L, Zagorski BM, Postill G, Nathens AB, Tillmann BW, Haas B
J Trauma Acute Care Surg
· 2026 Mar · PMID 41728878
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BACKGROUND: Survivors of severe traumatic injury remain at elevated risk of death in the years after injury. Little is known about how long-term mortality among injury survivors can be reduced. Given the importance of pr...BACKGROUND: Survivors of severe traumatic injury remain at elevated risk of death in the years after injury. Little is known about how long-term mortality among injury survivors can be reduced. Given the importance of primary care to overall health, we hypothesized that access to primary care would be associated with improved long-term survival among injury survivors. METHODS: This population-based, retrospective cohort study (2010-2022) included community-dwelling adults (18 years or older) discharged alive after a severe traumatic injury (Injury Severity Score, >15). The exposure of interest was access to primary care, defined as either visiting or being enrolled with a primary care physician in the 2 years prior to injury. The primary outcome was 5-year all-cause mortality. Cox proportional hazards models were used to evaluate the relationship between access to primary care and mortality, adjusting for sociodemographic characteristics, comorbidity, and injury severity. RESULTS: We identified 25,713 survivors of severe injury (mean age, 54 years; 32% female), of whom 92% (n = 23,720) had access to primary care. Five-year mortality was 13% (n = 3,265). Adjusting for patient characteristics, access to primary care was associated with a 20% lower hazard of death (hazard ratio, 0.80; 95% confidence interval, 0.68-0.93) at 5 years. The relationship between access to primary care and mortality was preserved across subgroups of age, sex, and comorbidity. CONCLUSION: Survivors of severe traumatic injury without access to primary care were more likely to die in the 5 years after discharge, identifying a vulnerable subset of the survivor population. Primary care physicians may represent key partners to trauma care providers in developing strategies that improve long-term outcomes in the years after injury. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.