Small-Volume ALM Therapy for Resuscitation and Stabilization Following Combined Burn Injury and Hemorrhagic Shock
Abstract
Background: Burn injury is a common threat in military environments and can result from either combat (primarily explosive device detonation), or non-combat causes such as waste burning, ammunition handling, and gasoline. Management of burn injury in combat settings is challenging, especially in austere, resource-limited environments, since it often occurs concomitantly with other trauma, including hemorrhage. No safe and effective drug therapy exists to treat burn injury and traumatic hemorrhage. Current treatment involving aggressive resuscitation with large volumes of fluid is not optimal and can contribute to complications including fluid build-up in the lungs and multiple organ failure. Burn injury also affects >2 million civilians in North America each year, with ~50,000 hospitalizations and 3,400 deaths. Our study addresses major unmet needs in both military and civilian settings. Objectives and Rationale: Our objective is to provide the U.S. Department of Defense (DOD) with a new frontline drug therapy to treat burn injury, trauma, and hemorrhage in the field immediately after the burn or injury has occurred, to resuscitate and stabilize the casualty prior to, and during, evacuation to definitive care. Our idea is to protect the whole body early after injury by blunting inflammation, stress, and dysfunction of the body s immune system. This will improve early survival and prevent secondary complications such as infection, burn encephalopathy (brain dysfunction), and respiratory failure. We have been developing a small-volume fluid therapy called ALM (for adenosine, lidocaine, and Mg2+), which has been shown to have pro-survival, protection, and stabilization properties, in small and large animal models of trauma, hemorrhage, traumatic brain injury, infection, cardiac arrest, and most recently, burns. The major aim of the proposed project is to evaluate the survival and protection effects in a military-relevant rat model of combined burn injury and hemorrhage. Focus Area: Complex combat-related burns: development of therapeutic interventions focused on treatment of burn injury in the polytrauma patient with concomitant pathology including hemorrhage Benefit to Burn Injured Service Members, Veterans, and the General Public: Our first-responder small-volume ALM therapy will buy time for the burn-injured and polytraumatized Warfighter at the point-of-injury, and en route stabilization to definitive care. Burn injury is a devastating trauma and is twice as likely to occur in Service Members compared with civilians. Our goal is to not only reduce early mortality from combat burns, but to also reduce secondary complications in survivors and improve the return-to-full-duty rate above 36% in burn-injured Service Members. The ALM therapy is also applicable to civilians suffering burns and other traumatic injuries due to road, work, and recreational accidents, especially those in regional, rural, and remote areas where resources are limited and evacuation to definitive care can be prolonged. Potential Clinical Applications, Benefits, and Risks: ALM drug therapy will help patients suffering burns and hemorrhage on the battlefield and in prehospital and hospital settings. The major benefit is the small volume (<50-fold lower than traditional resuscitation), which will provide a key logistical and tactical advantage to the DOD in far-forward, resource-limited, austere environments. Prolonged stabilization across the continuum-of-care is another key advantage of small-volume ALM therapy, particularly for future conflicts where casualties and combat medics may have to wait up to 7 days before resupply or safe evacuation. This also makes it ideal for mass casualty events, including terrorist attacks, which can involve a large number of patients with burns and polytrauma, to reduce the burden for first responders and medics. The new drug therapy will find wide utility in hospitals, MEDEVAC, Nav
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210556
Entities
People
- Geoffrey P Dobson
Organizations
- James Cook University
- United States Army