Assessment of hemodynamic changes in combat casualtieswith mine-explosive injuries in the process of aeromedical evacuations
Introduction. Rapid medical evacuation by air evacuation to skilled and specialized medical care facilities has become more effective since World War II and has been recognized as effective in being able to "clear the battlefield" and accelerate the evacuation of casualties to hospitals and clinical centers. However, the impact of aeromedical evacuation on patients with polytrauma is still poorly understood, especially in the case of mass evacuation when a wide range of patients may require sorting in harsh or extreme conditions with limited availability.
The purpose. Assess hemodynamic changes during aeromedical evacuation in victims with polytrauma and penetrating head injuries.
Materials and methods. A retrospective analysis of intensive care maps of 32 wounded and injured servicemen who were carried out by aeromedical evacuation from the area of anti-terrorist operation / joint force operation during 2017-2018.
Results.At the first stage of the study, it was found that the level of MAP at the ground stage of evacuations in the group with mine-explosive penetrating head injuries was 91.4 ± 5.9 mm Hg, while in victims with mine-explosive injuries of the abdomen and / or chest, it was significantly lower and was 87.5 ± 4.8 mm Hg (p <0,05). Pulse rates were 75.1 ± 4.7 and 79.4 ± 5.1 bpm. in the study groups, respectively (p <0,05). In the second stage of the study, a statistically significant decrease in hemodynamics and heart rate in the affected groups was found compared to baseline. Thus, in the 1st group MAP was 85.4 ± 4.8 mm Hg, heart rate 82.1 ± 6.3 (p <0.05), and in the second - 82.7 ± 4.9 mm. Hg, heart rate 86.2 ± 5.8 (p <0.05). In the subsequent stages (20 and 40 minutes) of aeromedical evacuation gradual stabilization of hemodynamics. At the final stage of evacuation in both study groups, heart rate and MAP were within the values obtained at the ground stage.
Conclusions. As a result of the study, it was found that in the second stage of the study (ascent) there were significant changes in hemodynamic parameters, which were manifested by hypotension and tachycardia (p <0.05), which were gradually corrected, and starting from stage 3 (20 min.) returned to baseline values in both study groups. In victims with mine-explosive injuries of the abdomen and / or chest in the 4th stage of the study, a decrease in MAP was observed, which may indicate greater hemodynamic instability in this study group.
Ena, A.I., Lurin, I.A., Kravchuk, V.V.and others (2010). Aeromedychna evakuatsiia: textbook. Ternopil: TSMU, 2010. 192 p. [in Ukrainian].
Joshi, M.C., Sharma, R.M. (2010). Aero-medical considerations in casualty air evacuation (CASAEVAC). Med J Armed Forces India. 66(1): 63–5.
Bradley, M., Nealeigh, M., Oh, J.S., Rothberg, P., Elster, E.A., Rich, N.M. (2017). Combat casualty care and lessons learned from the past 100 years of war. Curr Probl Surg. 54(6):315–351.
Fiskum G.PJ., Medina, .J, Rangghran, P., Coksayan, T., Gullpalli, R., Kozar, R. (2019). Mechanism by which aeromedicalevacuation relevant hyрobaria wоrsеns mortality follоwng polytrauma. [Abstract.] Aerosp Med Hum Perform.; 90(3):196.
Scultetus, A.H., Haque, A., Chun, S.J., et al (2016). Brain hyрoxia is exacerbated in hypobaria during aеromedical evacuation in swine with traumatic brain injury. J Trauma Acute Care Surg 81(1): 101–7.
Skovira, J.W., Kabadi, S.V., Wu, J., et al (2016). Simulated aеromedical evacuation exacerbates experimеntal brain injury. J Neurotrauma. 33(14): 1292–302.
Daniel, Y., Habas, S., Malan, L., Escarment, J., David, J-S., Peyrefitte, S. (2016). Tactical damage control rеsuscitation in austere military еnvironments. J R Army Med Corps. 162(6): 419–27.
Albreiki, M., Voegeli, D. (2018). Pеrmissive hypotensive rеsuscitation in adult patients with traumatic haеmorrhagic shock: a systematic review. Eur J Trauma Emerg Surg. 44(2): 191–202.
This work is licensed under a Creative Commons Attribution 4.0 International License.