Battlefield resuscitation of the future

The problem of hemorrhage and combat resuscitation can be examined using the economic analogy of supply and demand as it applies to oxygen delivery. Blood carries oxygen to the tissues and organs, and thus the "supply" is a function of how much blood is circulating and how much oxygen it is carrying. The "demand" is a function of how much oxygen that tissue requires to maintain basic function, and how well it can adapt to decreased levels of delivery. Almost all of the past and current strategies to treat hemorrhage have focused on augmenting the supply side of the equation; stopping bleeding, resuscitating with fluids and blood products, and maintaining high oxygen levels in the blood. While this remains an important area for further advances, we believe that cutting-edge or "next-generation" advances that primarily target the demand side have the potential to drastically impact battlefield mortality and morbidity and to fundamentally alter our approach to hemorrhagic shock. By reducing, or even temporarily eliminating, the injured patient's dependence on oxygen delivery, these therapies have the potential to expand the window of survivability from severe or even previously fatal injuries. This chapter reviews multiple novel approaches, ongoing research, and near-future interventions that may drastically alter the way we provide care for our wounded service members on the battlefield of the future.