New low volume resuscitation solution customized for pre-hospital and ICU mechanisms of injury in the complex trauma patient.
Abstract
Death and injury from severe battlefield trauma is a significant problem. Severe hemorrhage is a frequent cause of death on the battlefield, so being able to increase a patient’s resistance to blood loss is an important goal because replacing their blood loss is not realistic in austere battlefield conditions. The two main problems that Soldiers with severe trauma and hemorrhage experience in the field are the ability to survive the initial blood loss early after the traumatic event and the high risk of dying from complications in the Intensive Care Unit (ICU) (critical illness) if they are lucky enough to survive the early event. Therefore, our goal was to employ two distinct drugs and strategies into one new intravenous (IV) solution that specifically targets both the early resuscitation phase and the later critical illness phase in the ICU. This should provide a more comprehensive strategy for saving lives under these challenging conditions. Therefore, the objective of this study is to test a new IV solution containing (1) Polyethylene Glycol 20,000 (PEG-20k), a stable drug that reverses the problems created by massive blood loss, and (2) vitamin C, which prevents later development of critical illness in the ICU. This treatment targets severely injured Soldiers on the battlefield and civilians in similar trauma settings (vehicle accidents). When used separately, PEG-20k solutions increase the golden hour after hemorrhage 17-fold, compared to conventional IV treatments. High-dose vitamin C significantly averts the incidence of lung injury and sepsis in ICU patients. Since both agents are remarkably stable, it makes sense to combine the two into one solution to be given to Soldiers on the battlefield to resuscitate them and compare those results from the standard IV solutions. Therefore, we will test this new solution with each component separately and then combined to see any additive effects. Then we will test the new solutions against what is currently used to resuscitate Soldiers (an IV solution called Hextend) and civilian trauma patients (IV saline). We developed preclinical hemorrhage and ICU models in anesthetized pigs over 2 days to test these solutions. The anesthetized pigs mimic a Soldier’s response to injury, so they should also accurately reflect how Soldiers will respond to the solutions. The study will last 3 years and require an additional 2-3 years to get approved and begin testing in patients for deployment. At the end of this study, we will have characterized the response of a new IV solution used to resuscitate injured Soldiers with severe hemorrhage on the field. The solutions will be shown to increase the golden hour and transport times 10-fold over current solutions and significantly reduce the incidence of life-threatening complications in the ICU for those lucky enough to make it to the ICU.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810759
Entities
People
- Martin J Mangino
Organizations
- United States Army
- Virginia Commonwealth University