2. military trauma research gaps final

8/18/2019 2. Military Trauma Research Gaps Final

1/22

Military TraumaClinical Knowledge Gaps

& Research Opportunities

COL Brian Eastridge, M, !"C#

Trauma Consultant, $# "rmy #urgeon General

%T#, $#"#R


2/22

isclaimer

The opinions or assertions contained

herein are the private views of the

author and are not to be construed asofficial or as reflecting the views of

the Department of the Army or the

Department of Defense.


3/22

Military Trauma Research

Gaps

'oint o( n)ury * 're+hospital Care

• Releant and realistic documentation

solutions (or pre+hospital care proiders

• Li(e saing interention e((icacy

• -alidation concepts Tactical Com.at

Casualty Care

3


4/22


Gaps

/emorrhage

• Local and systemic hemostatic agents (or the

control o( compressi.le and non+compressi.le

hemorrhage

• mproed preseration, storage,

transporta.ility, and processing o( red .lood

cells, platelets, and plasma – !orward adapta.ility o( damage control

resuscitation concepts

4


5/22


Gaps

• /emorrhage• Treatments to enhance o0ygen deliery and

per(usion

• E1uipment and procedures (or e((ectie (luid

resuscitation o( casualties

• Enhanced * optimi2ed resuscitation (luids


6/22

O3

4on+#uria.le Etiology

Eastridge et al, J Trauma 2011


7/22

O3

'otentially #uria.le Etiology



8/22

O3 5'otentially #uria.le6

/emorrhage !ocus



9/22


Gaps

Coagulopathy

• iagnostics and therapeutics to predict,

diagnose, preent, and treat trauma

coagulopathy

• 4oninasie or minimally inasie sensors

to detect and warn o( impending ascular

collapse and*or signi(icant tissue damagedue to per(usion de(icits

9


10/22

Blood * Coagulation

•

4ear /ori2on – Transition o( !ree2e+ried

'lasma and Cryo+'resered'latelets to "dancedeelopment 5clinical trials6

• Current !ocus "reas – $nderstanding .asic

mechanisms o( trauma+induced coagulopathy

– eeloping improedplatelet storage systems

– eeloping .lood productpathogen reductiontechnologies


11/22


Gaps

Orthopaedic Trauma

• /ealing o( segmental .one de(ects

• 'reention o( heterotopic ossi(ication

• /ealing o( massie so(t tissue de(ects

• Tissue ia.ility assessment and wound

irrigation * de.ridement technologies

• 3ound n(ection * n(ection Control

11


12/22


Gaps

Massie #o(t Tissue n)ury

• rugs, deices, or noel surgical

techni1ues to decontaminate, de.ride,

protect, and sta.ili2e hard and so(ttissue wounds to mitigate secondary

tissue damage

• Replacement or regeneration o( lost

tissues * organs

12


13/22

E0tremity Trauma &

Regeneratie Medicine

• e(ining the in)ury patternsand resulting (unctionaloutcomes

• Open (ractures• #o(t tissue de(ects 5muscle and

nere6• 3ound irrigation and de.ridement

• Current !ocus "reas – "nimal modeling o( traumatic in)ury

• #egmental de(ects• 3ound contamination and in(ection

– Muscle * .one regeneration – eliery o( autologous stem cells to

treat de(ects


14/22

Battlefield Injury

Face 7%Face 7%

Eye 3%Eye 3%

Head/Neck 2%Head/Neck 2%

Head/Neck

27%

Head/Neck

27%

!est "%!est "%

#$dme& '%#$dme& '%

(el)is/ *rge&ital 3%(el)is/ *rge&ital 3%

Tru&k/+ack/+uttck 1%Tru&k/+ack/+uttck 1%

Trs

1"%

Trs

1"%

3%3%

-i&e/+ack 3%-i&e/+ack 3%

!ulder/*--er #rm '%!ulder/*--er #rm '%

Frearm/El$. '%Frearm/El$. '%

rist/Ha&d/Fi&gers 7%rist/Ha&d/Fi&gers 7%

t!er 3%t!er 3%

*--erEtremities

22%

*--erEtremities

22%

Hi-/*--er eg/T!ig! "%Hi-/*--er eg/T!ig! "%

Ft/Tes "%Ft/Tes "%

&ee/.er eg/#&kle 9%&ee/.er eg/#&kle 9%

.er

Etremities

31%

.er

Etremities

31%t!er 12%t!er 12%

t!er 2%t!er 2%

Head/Neck *&s-ec 3%Head/Neck *&s-ec 3%

+rai& &5ury 6T+ 12%


15/22


Gaps

Traumatic Brain n)ury

• Mitigation secondary .rain*spinal cord

damage

• 4on+ or minimally+inasie sensors or

assays to rapidly diagnose the seerity o(

.rain and spinal cord in)ury within the .attle

area or as close to it as possi.le

• rugs, .iologics, or other agents to mitigate

post+in)ury neural and immune cell oer+

stimulation, in(lammation, cell loss, and

neurologic dys(unction 1"


16/22


Gaps

#econdary cell and organ damage

• schemia*reper(usion in)ury

• Cell death

• Organ (ailure

• Methods to reduce cellular demand (or

o0ygen and meta.olic su.strates

– Re(raming physiologic maintenance

» emand ersus supply

• Therapeutics to modulate the immune

response to traumatic in)ury1'


17/22


Gaps

Battle(ield and En+route 'ain

Management

• Minimal e((ects on physical and

cognitie per(ormance (or mission

capa.ility

• Minimi2e cardiac and respiratory

depression• Minimal or no potential (or addiction

17


18/22

'ain Control• Opportunities

– 4oel agents * uses e0isting agents• Battle(ield, MT!, and enroute

– Regional pain therapy

– e(ining the relationship .etween pain control and 'ost Traumatic #tress isorder

– 4ontraditional therapies

• -irtual reality immersie

enironments (or pain control

• "cupuncture


19/22


Gaps

Eacuation o( the Critically

n)ured Casualty

• /ypo.aria e((ects in strateac

•

'hysiological e((ects o( i.ration, shoc7 and G+(orces

• eelopment o( non+inasie sensors, diagnostic

and prognostic algorithms and processors (or

remote triage, monitoring, and management o(casualties

• ecision support 5computer assisted6

• "utonomous control systems19


20/22


Gaps

Burn

• -ia.le transitional s7in products to

austere enironments

• 'rotecting s7in gra(ts (rom immunerecognition

• Replacement and regeneration o(

s7in

20


21/22


Gaps

Eye, Ear and Cranio(acial n)ury

• 'reention and treatment o(

cranio(acial and dental in)ury *

disease in austere enironments• Cranio(acial reconstruction

alternaties

– Transplantation

– Tissue regeneration

21


22/22

8uestions9

2. military trauma research gaps final

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