TY - JOUR
T1 - Simulated aeromedical evacuation in a polytrauma rat model
AU - Arnaud, Françoise
AU - Pappas, Georgina
AU - Maudlin-Jeronimo, Eric
AU - Goforth, Carl
N1 - Funding Information:
The authors thank Dr. Richard McCarron for his help in acquiring funding for this study; Dr. Ye Chen and Mike Hammett for assistance with bio-assays; and Dr. Melissa Mehalick for assistance with statistics and editorial assistance with the manuscript. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions or policies of the Uniformed Services University of the Health Sciences (USUHS), The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense (DoD), or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. This work has been presented, in part, as a poster at the Neurotrauma meeting 25-30 June 2016, Lexington, KY, and 7-11 July 2017, Snowbird, UT, and at the Military Health System Research Symposium (MHSRS), 27-30 August 2017, Kissimmee, FL. Financial Disclosure Statement: This work was supported by the DHP 603115HP.2380.001.A1304. None of the authors have any commercial associations that might create a conflict of interest nor do any of the authors have any financial interests or personal relationships with other people or organizations that would represent a conflict of interest.
Funding Information:
Financial Disclosure Statement: This work was supported by the DHP 603115HP.2380.001.A1304. None of the authors have any commercial associations that might create a conflict of interest nor do any of the authors have any financial interests or personal relationships with other people or organizations that would represent a conflict of interest.
Publisher Copyright:
© The Authors.
PY - 2019
Y1 - 2019
N2 - BACKGROUND: Hemorrhage and traumatic brain injury can be lethal if left unattended. The transportation of severely wounded combat casualties from the battlefield to higher level of care via aeromedical evacuation (AE) may result in unintended complications. This could become a serious concern at the time of evacuation of mass casualties or for prolonged field care scenarios with limited resources. METHODS: Following instrumentation (t1), anesthetized Sprague-Dawley rats were injured or not [75-kPa blast and 30% estimated blood-volume controlled hemorrhage] (t2). After 15 min, all rats were resuscitated with saline. During the simulated 3-h evacuation, 8000 ft (2440 m) vs. sea-level heart rate, temperature, and oxygenation (Spo2) were continuously recorded. One group of rats was euthanized immediately after evacuation (t3) and another after a 72-h recovery period (t4). Hematology and metabolic levels were measured at t1, t2, t3, and t4. RESULTS: Survival was 100% in control-uninjured animals, 83% in injured animals under normobaria, and significantly reduced to 50% under hypobaria. This AE setting resulted in significantly lower hemodynamics, thermoregulation, and oxygenation parameters in the animals under hypobaria than those under normobaria. The initial lower mean arterial pressure (MAP) with the reduced oxygen level before AE were critical factors for the survival of injured animals. We observed a general increase of white blood cells and platelet ability to aggregate at t4 in all experimental groups. CONCLUSION: Physiological parameters were affected during aeromedical evacuation in all groups. This was worsened for injured animals with MAP less than 60 mmHg associated with low Spo2 in a simulated aeromedical evacuation. This represented a high risk of mortality for severely polytraumatized animals.
AB - BACKGROUND: Hemorrhage and traumatic brain injury can be lethal if left unattended. The transportation of severely wounded combat casualties from the battlefield to higher level of care via aeromedical evacuation (AE) may result in unintended complications. This could become a serious concern at the time of evacuation of mass casualties or for prolonged field care scenarios with limited resources. METHODS: Following instrumentation (t1), anesthetized Sprague-Dawley rats were injured or not [75-kPa blast and 30% estimated blood-volume controlled hemorrhage] (t2). After 15 min, all rats were resuscitated with saline. During the simulated 3-h evacuation, 8000 ft (2440 m) vs. sea-level heart rate, temperature, and oxygenation (Spo2) were continuously recorded. One group of rats was euthanized immediately after evacuation (t3) and another after a 72-h recovery period (t4). Hematology and metabolic levels were measured at t1, t2, t3, and t4. RESULTS: Survival was 100% in control-uninjured animals, 83% in injured animals under normobaria, and significantly reduced to 50% under hypobaria. This AE setting resulted in significantly lower hemodynamics, thermoregulation, and oxygenation parameters in the animals under hypobaria than those under normobaria. The initial lower mean arterial pressure (MAP) with the reduced oxygen level before AE were critical factors for the survival of injured animals. We observed a general increase of white blood cells and platelet ability to aggregate at t4 in all experimental groups. CONCLUSION: Physiological parameters were affected during aeromedical evacuation in all groups. This was worsened for injured animals with MAP less than 60 mmHg associated with low Spo2 in a simulated aeromedical evacuation. This represented a high risk of mortality for severely polytraumatized animals.
KW - Aero-evacuation
KW - Altitude
KW - Blast
KW - Hemorrhage
KW - Hypobaria
KW - Resuscitation
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85075478550&partnerID=8YFLogxK
U2 - 10.3357/AMHP.5477.2019
DO - 10.3357/AMHP.5477.2019
M3 - Article
C2 - 31747998
AN - SCOPUS:85075478550
SN - 2375-6314
VL - 90
SP - 1016
EP - 1025
JO - Aerospace Medicine and Human Performance
JF - Aerospace Medicine and Human Performance
IS - 12
ER -