Decision Support for Damage Control Resuscitation: Hemorrhage Helper

Background: Acute hemorrhage remains the leading cause of potentially preventable death from trauma in both military and civilian patients. Although trauma outcomes have generally improved in recent years, these benefits have not extended to moderately injured patients in hemorrhagic shock. Damage control resuscitation (DCR) represents a promising approach to mitigating these disappointment results by reducing death from hemorrhage. However, rapidly recognizing a patient in hemorrhagic shock while simultaneously orchestrating a team resuscitation response in an orderly and evidence-based manner proves very difficult even under the best circumstances. Furthermore, best practice in the area of DCR is frequently changing, making it even more difficult to remain current in the application of DCR principles.To address these challenges that limit the application of DCR best practice, we propose to further develop and evaluate a DCR decision support system, the Hemorrhage Helper. This system will (1) project the likelihood that a given patient will require a massive transfusion (MT) based on real-time mechanistic, physiologic, and laboratory data; (2) display current blood product and resuscitation adjunct tallies in a location easily visible to the entire resuscitation team; and (3) provide the resuscitation team leader with a rule-based recommendation on the next resuscitation product to be given using a customizable decision algorithm based on the most current DCR research evidence.Objective/Hypothesis: We hypothesize that an integrated decision support system for DCR will enable more rapid identification of patients who need MT and will improve the adherence to specific principles of DCR during the initial course of management.Specific Aims: To test this hypothesis, have defined three objectives. (1) Define the potential benefit by conducting a post-hoc analysis of previously conducted studies — PROMMTT and PROPPR — in which detailed resuscitation data were collected along with accurate time stamps. (2) System development to include improved ergonomics, efficiency, and safety of our prototype Hemorrhage Helper system. (3) System evaluation to include validation that our system provided timely and accurate recommendations, is optimized from a human factors standpoint, and can be safely utilized in the clinical setting of the Trauma Center at the University of Pennsylvania.Study Design: This project includes four different studies. (1) A post-hoc analysis of the PROMMTT and PROPPR data sets will define the current standard of care for the timeframe in which DCR principles should be applied. (2) Performance of the decision support system will be validated using virtual patient scenarios. (3) Human factors analysis will be completed on the system. (4) Finally, a prospective pilot study will be performed in which this system will be used to provide decision support during trauma resuscitations.Relevance: The proposed project aligns with the following Combat Casualty Care Research Program (CCCRP) Areas of Interest: (1) develop technologies to limit the immediate, short-, and long-term deleterious consequences of severe hemorrhage and (2) reduce acute secondary organ damage. The outcome of this proposal will include a more detailed understanding of the strict time pressure under which DCR must be applied while also offering a decision support solution that will aid military and civilian trauma providers alike in meeting these demands even in the suboptimal conditions of an austere environment.