title: Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial.
abstract: BACKGROUND
  Optimal emergent management of traumatic hemorrhagic shock patients requires a better understanding of treatment provided in the prehospital/Emergency Medical Services (EMS) and emergency department (ED) settings. Hypothesis/Problem Described in this research are the initial clinical status, airway management, fluid and blood infusions, and time course of severely-injured hemorrhagic shock patients in the EMS and ED settings from the diaspirin cross-linked hemoglobin (DCLHb) clinical trial.
  
  
  METHODS
  Data were analyzed from 17 US trauma centers gathered during a randomized, controlled, single-blinded efficacy trial of a hemoglobin solution (DCLHb) as add-on therapy versus standard therapy.
  
  
  RESULTS
  Among the 98 randomized patients, the mean EMS Glasgow Coma Scale (GCS) was 10.6 (SD = 5.0), the mean EMS revised trauma score (RTS) was 6.3 (SD = 1.9), and the mean injury severity score (ISS) was 31 (SD = 17). Upon arrival to the ED, the GCS was 20% lower (7.8 (SD = 5.3) vs 9.7 (SD = 6.3)) and the RTS was 12% lower (5.3 (SD = 2.0) vs 6.0 (SD = 2.1)) than EMS values in blunt trauma patients (P < .001). By ED disposition, 80% of patients (78/98) were intubated. Rapid sequence intubation (RSI) was utilized in 77% (60/78), most often utilizing succinylcholine (65%) and midazolam (50%). The mean crystalloid volume infused was 4.2 L (SD = 3.4 L), 80% of which was infused within the ED. Emergency department blood transfusion occurred in 62% of patients, with an average transfused volume of 1.2 L (SD = 2.0 L). Blunt trauma patients received 2.1 times more total fluids (7.4 L vs 3.5 L, < .001) and 2.4 times more blood (2.4 L vs 1.0 L, P < .001). The mean time of patients taken from injury site to operating room (OR) was 113 minutes (SD = 87 minutes). Twenty-one (30%) of the 70 patients taken to the OR from the ED were sent within 60 minutes of the estimated injury time. Penetrating trauma patients were taken to the OR 52% sooner than blunt trauma patients (72 minutes vs 149 minutes, P < .001).
  
  
  CONCLUSIONS
  Both GCS and RTS decreased prior to ED arrival in blunt trauma patients. Intubation was performed using RSI, and crystalloid infusion of three times the estimated blood loss volume (L) and blood transfusion of the estimated blood loss volume (L) were provided in the EMS and ED settings. Surgical intervention for these trauma patients most often occurred more than one hour from the time of injury. Penetrating trauma patients received surgical intervention more rapidly than those with a blunt trauma mechanism.
authors.affiliation: 1Department of Emergency Medicine,University of Illinois at Chicago,Chicago,IllinoisUSA.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Sloan
authors.affiliation: 2Advocate Illinois Masonic Medical Center,Chicago,IllinoisUSA.
authors.forename: Max
authors.initials: M
authors.lastname: Koenigsberg
authors.affiliation: 3Carle Physician Group,Department of Emergency Medicine,University of Illinois College of Medicine at Urbana-Champaign,Urbana-Champaign,IllinoisUSA.
authors.forename: W Brad
authors.initials: WB
authors.lastname: Weir
authors.affiliation: 4Rush Medical College,Rush University Medical Center,Chicago,IllinoisUSA.
authors.forename: James M
authors.initials: JM
authors.lastname: Clark
authors.affiliation: 5Department of Emergency Medicine,University of Virginia,Charlottesville,VirginiaUSA.
authors.forename: Robert
authors.initials: R
authors.lastname: O'Connor
authors.affiliation: 6Department of Emergency Medicine,Indiana University,Indianapolis,IndianaUSA.
authors.forename: Michael
authors.initials: M
authors.lastname: Olinger
authors.affiliation: 7Department of Emergency Medicine,Case Western Reserve University,Cleveland,OhioUSA.
authors.forename: Rita
authors.initials: R
authors.lastname: Cydulka
mesh_terms: D000328:Adult; D058109:Airway Management; D001241:Aspirin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001802:Blood Substitutes / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004638:Emergency Treatment; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D015600:Glasgow Coma Scale; D006454:Hemoglobins / Q000627:therapeutic use*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D001802:Blood Substitutes; D006454:Hemoglobins; C083478:diaspirin-cross-linked hemoglobin; D001241:Aspirin
keywords: DCLHb diaspirin cross-linked hemoglobin; ED emergency department; EMS Emergency Medical Services; ETI endotracheal intubation; GCS Glasgow Coma Scale; HR heart rate; ISS injury severity score; IV intravenous; MOI mechanism of injury; OR operating room; PRBC packed red blood cell; RR respiratory rate; RSI rapid sequence intubation; RTS revised trauma score; SBC systolic blood pressure; T-RTS triage revised trauma score; TBI traumatic brain injury; wounds and injuries