Far forward gaps in hemorrhagic shock and prolonged field care: an update of ALM fluid therapy for field use

Dobson, Geoffrey P., and Letson, Hayley L. (2020) Far forward gaps in hemorrhagic shock and prolonged field care: an update of ALM fluid therapy for field use. Journal of Special Operations Medicine, 20 (3). pp. 128-134.

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Abstract

Future expeditionary missions are expected to occur in more remote austere environments where combat medics and casualties may have to wait up to 7 days before resupply or safe evacuation. Currently, there is no effective fluid therapy for hemorrhagic shock (HS) at the point-of-injury and continuum-of-care over this extended period. We have been developing a small-volume IV or IO ALM therapy for noncompressible HS and have shown in preclinical models that it extends survival to 3 days, reduces abdominal bleeding by 60%, blunts inflammation, corrects coagulopathy, preserves platelet function, and prevents immunodeficiency. The ALM-survival phenotype is associated with an upregulation of the master genes of metabolism and mitochrondrial biogenesis in heart and brain and a downregulation in the periphery. Future translational studies will investigate the timing and nature of the "switch" and extend survival to 7 days. We will also discuss some of the controversies of ALM resuscitation in pigs, present our Systems Hypothesis of Trauma (SHOT), and discuss future clinical safety trials before field use.

Item ID: 64530
Item Type: Article (Research - C1)
ISSN: 1553-9768
Keywords: hemorrhage; trauma; survival; genetics; metabolism; inflammation; military medicine; resuscitation
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Funders: USSOCOM
Projects and Grants: W81XWH-USSOCOM-BAA-15-1
Date Deposited: 06 Oct 2020 02:22
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110299 Cardiovascular Medicine and Haematology not elsewhere classified @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110305 Emergency Medicine @ 50%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 50%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 50%
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