Military Trauma Clinical Knowledge Gaps & Research Opportunities

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Military Trauma Clinical Knowledge Gaps
Research Opportunities

• COL Brian Eastridge, MD, FACS
• Trauma Consultant, US Army Surgeon General
• JTS, USAISR

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Disclaimer

• The opinions or assertions contained herein are
  the private views of the author and are not to be
  construed as official or as reflecting the views
  of the Department of the Army or the Department
  of Defense.

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Military Trauma Research Gaps

• Point of Injury / Pre-hospital Care
• Relevant and realistic documentation solutions
  for pre-hospital care providers
• Life saving intervention efficacy
• Validation concepts Tactical Combat Casualty Care

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Military Trauma Research Gaps

• Hemorrhage
• Local and systemic hemostatic agents for the
  control of compressible and non-compressible
  hemorrhage
• Improved preservation, storage, transportability,
  and processing of red blood cells, platelets, and
  plasma
• Forward adaptability of damage control
  resuscitation concepts

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Military Trauma Research Gaps

• Hemorrhage
• Treatments to enhance oxygen delivery and
  perfusion
• Equipment and procedures for effective fluid
  resuscitation of casualties
• Enhanced / optimized resuscitation fluids

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DOWNon-Survivable Etiology
Eastridge et al, J Trauma 2011
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DOWPotentially Survivable Etiology
Eastridge et al, J Trauma 2011
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DOW (Potentially Survivable)Hemorrhage Focus
Eastridge et al, J Trauma 2011
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Military Trauma Research Gaps

• Coagulopathy
• Diagnostics and therapeutics to predict,
  diagnose, prevent, and treat trauma coagulopathy
• Noninvasive or minimally invasive sensors to
  detect and warn of impending vascular collapse
  and/or significant tissue damage due to perfusion
  deficits

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Blood / Coagulation

• Near Horizon
• Transition of Freeze-Dried Plasma and
  Cryo-Preserved Platelets to Advanced Development
  (clinical trials)
• Current Focus Areas
• Understanding basic mechanisms of trauma-induced
  coagulopathy
• Developing improved platelet storage systems
• Developing blood product pathogen reduction
  technologies

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Military Trauma Research Gaps

• Orthopaedic Trauma
• Healing of segmental bone defects
• Prevention of heterotopic ossification
• Healing of massive soft tissue defects
• Tissue viability assessment and wound irrigation
  / debridement technologies
• Wound Infection / Infection Control

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Military Trauma Research Gaps

• Massive Soft Tissue Injury
• Drugs, devices, or novel surgical techniques to
  decontaminate, debride, protect, and stabilize
  hard and soft tissue wounds to mitigate secondary
  tissue damage
• Replacement or regeneration of lost tissues /
  organs

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Extremity Trauma Regenerative Medicine

• Defining the injury patterns and resulting
  functional outcomes
• Open fractures
• Soft tissue defects (muscle and nerve)
• Wound irrigation and debridement
• Current Focus Areas
• Animal modeling of traumatic injury
• Segmental defects
• Wound contamination and infection
• Muscle / bone regeneration
• Delivery of autologous stem cells to treat defects

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Battlefield Injury
Upper Extremities 22
Head/Neck 27
Brain Injury (TBI) 12
Shoulder/Upper Arm 6
Face 7
Forearm/Elbow 6
Eye 3
Wrist/Hand/Fingers 7
Other 3
Head/Neck 2
Head/Neck Unspec 3
Spine/Back 3
3
Lower Extremities 31
Chest 5
Hip/Upper Leg/Thigh 5
Torso 15
Abdomen 6
Knee/Lower Leg/Ankle 9
Pelvis/ Urogenital 3
Foot/Toes 5
Trunk/Back/Buttock 1
Other 12
Other 2
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Military Trauma Research Gaps

• Traumatic Brain Injury
• Mitigation secondary brain/spinal cord damage
• Non- or minimally-invasive sensors or assays to
  rapidly diagnose the severity of brain and spinal
  cord injury within the battle area or as close to
  it as possible
• Drugs, biologics, or other agents to mitigate
  post-injury neural and immune cell
  over-stimulation, inflammation, cell loss, and
  neurologic dysfunction

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Military Trauma Research Gaps

• Secondary cell and organ damage
• Ischemia/reperfusion injury
• Cell death
• Organ failure
• Methods to reduce cellular demand for oxygen and
  metabolic substrates
• Reframing physiologic maintenance
• Demand versus supply
• Therapeutics to modulate the immune response to
  traumatic injury

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Military Trauma Research Gaps

• Battlefield and En-route Pain Management
• Minimal effects on physical and cognitive
  performance for mission capability
• Minimize cardiac and respiratory depression
• Minimal or no potential for addiction

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Pain Control

• Opportunities
• Novel agents / uses existing agents
• Battlefield, MTF, and enroute
• Regional pain therapy
• Defining the relationship between pain control
  and Post Traumatic Stress Disorder
• Nontraditional therapies
• Virtual reality immersive
• environments for pain control
• Acupuncture

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Military Trauma Research Gaps

• Evacuation of the Critically
• Injured Casualty
• Hypobaria effects in stratevac
• Physiological effects of vibration, shock and
  G-forces
• Development of non-invasive sensors, diagnostic
  and prognostic algorithms and processors for
  remote triage, monitoring, and management of
  casualties
• Decision support (computer assisted)
• Autonomous control systems

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Military Trauma Research Gaps

• Burn
• Viable transitional skin products to austere
  environments
• Protecting skin grafts from immune recognition
• Replacement and regeneration of skin

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Military Trauma Research Gaps

• Eye, Ear and Craniofacial Injury
• Prevention and treatment of craniofacial and
  dental injury / disease in austere environments
• Craniofacial reconstruction alternatives
• Transplantation
• Tissue regeneration

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Questions?