Army Invention Saves Severely Injured Servicemembers’ Lives
By Elaine Wilson
Special to American Forces Press Service
FORT SAM HOUSTON, Texas, Jun. 13, 2008 A new lifesaving standard of care has garnered the U.S. Army Institute of Surgical Research here a prestigious recognition: invention of the year.
The innovation, called Damage Control Resuscitation of Severely Injured Soldiers, was named one of the Army’s “Top Ten Greatest Inventions of 2007.”
“The American Association for Trauma Surgeons calls this one of the biggest improvements to trauma care in the last 10 years,” said Michael Dubick, senior research pharmacologist for the Institute of Surgical Research. The invention is aimed at saving severely injured soldiers with internal injuries that cannot be compressed using a tourniquet or other device, Dubick said.
The institute focused its attention on severely injured soldiers after analyzing data from an autopsy study that showed 79 percent of servicemembers killed in combat died of hemorrhage, and 70 percent had an injury that couldn’t be compressed.
“We needed to find a better way to stop bleeding,” Dubick said. “In theater, there was no solution for people with noncompressible injuries.”
The innovation involves the fluid resuscitation process, in which IV fluids and blood products are used to stabilize a patient’s physiology. The standard method is to administer IV salt solutions in an amount that is three times the patient’s blood volume. If the patient is still bleeding, blood transfusions are given to restore lost blood.
In most cases, this method is effective for wounded troops, but for some severely injured warriors, the massive volume of fluids and blood can create a negative effect, Dubick said.
“The body has only a finite amount of clotting factors,” he explained, “and a large volume of fluids can dilute those clotting factors, which reduces their ability to slow down or stop the bleeding.”
Under the new standard of care, fluid resuscitation with salt solutions is limited, which keeps the blood pressure from rising too high and “popping” newly formed blood clots. In addition, blood volume is restored using plasma as the primary resuscitation fluid, along with packed red blood cells.
But rather than using the standard of four times the amount of red blood cells to plasma, “we use a ratio of 1-to-1 of plasma to red blood cells,” Dubick said.
Dubick said early use of a clotting factor called “rFVIIa” also has been beneficial. The factor normally is used for hemophiliacs, but it has proven beneficial for severely injured warriors. Other blood products, such as platelets and “cryoprecipitate,” are used as needed.
The reduction in fluids not only increases the patient’s short-term chances of survival, but also helps long-term treatment, since “there is less fluid built up in organs, and surgeons have a better field of operation,” Dubick said.
While the innovation is gaining recognition stateside, it already has had a striking impact in the combat theater, decreasing the mortality rate from 65 to 17 percent.
The impact of this change in the standard of care is so striking, Dubick said, that “some liken this standard of care to the first time someone applied antibiotics.”
The military innovation also is gaining civilian attention.
“We’ve met with over 26 civilian centers and are working with 16 of them,” Dubick said.
As word of the lifesaving measure begins to spread, Dubick said, he and his fellow scientists already are looking ahead, working with a company to produce freeze-dried plasma. In its natural state, plasma has a limited shelf life and is subject to temperature requirements.
The scientists also would like to develop a shelf-stable artificial blood with clotting factors that would enable medics to provide early intervention at the site of injury, Dubick said.
“The majority of patients bleed to death in the first five to 10 minutes,” Dubick said. “We believe that procedures like this one can save soldiers who survive beyond 10 minutes -- keep them alive long enough to get to the hospital and to surgery. It’s a remarkable innovation.”
Dubick’s team for the project includes Jill Sondeen and Charles Wade, from the Institute of Surgical Research; Philip Spinella, Brooke Army Medical Center; Army Maj. Jeremy Perkins, Walter Reed Army Medical Center, Washington, D.C.; Air Force Maj. Matthew Borgman, Wilford Hall Medical Center; and Army Col. John Holcomb, ISR commander.
The invention was the only medical innovation to make the Army’s Top Ten cut, and marks the third year of the last four that the Institute of Surgical Research has made it to the Top Ten list. The winning programs are selected based on their impact on Army capabilities, inventiveness and potential benefit outside the Army.
U.S. Army Institute of Surgical Research http://www.usaisr.amedd.army.mil/
(Elaine Wilson works at the Fort Sam Houston Public Information Office.)