Dependence on anesthesiology support in victims with combined mine-explosive thoraco-abdominal injuries and penetrating head injuries at the stage of preparation and conducting of aeromedical evacuation

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Ukrainian Military Medical Academy

Аnesthesiology and resuscitation department

Dependence on anesthesiology support in victims with combined mine-explosive thoraco-abdominal injuries and penetrating head injuries at the stage of preparation and conducting of aeromedical evacuation

Ukhach Yu.D., MD, PhD-student

Kyiv, Ukraine

Introduction

Explosive injuries account for more than 50% of all injuries received in military battles, and the proportion of casualties among the civilian population is also increasing [1]. However, only limited research has been conducted on the pathophysiology of blast-induced brain injury, and the effect of changes in cerebral blood flow (CBF) or cerebral vascular reactivity on blast-induced brain injury has not been investigated [2]. Although secondary hypotension and hypoxemia are associated with increased mortality and morbidity after blunt head injury, the effect of secondary injury factors in blast injury is unknown [2]. TBI itself causes cerebral hypoperfusion, reduced oxygen delivery to the brain, excitotoxicity, and disruption of cerebral blood flow autoregulation, which explains the vulnerability of the affected brain to hypoxia and hypotension caused by blood loss [2,3].

Efforts to optimize medical management and physiologic stabilization during casualty care, specialized care during evacuation, and initial surgical stabilization of severe TBI may help mitigate the effect of longer delays to specialized neurosurgical care [4].

The purpose. To assess the need of injured servicemen with combined mineexplosive thoraco-abdominal injuries and penetrating head injuries in intensive care measures at the stage of preparation and conducting of aeromedical evacuation.

Materials and methods

The study retrospectively analyzed the medical records of 122 injured servicemen who underwent aeromedical evacuation (AME) by helicopters from field hospitals for transfer to the stage of specialized medical care over a period of 3 years (2016-2019). Depending on the severity of brain damage, victims with combat trauma were assessed according to the Glasgow Coma Scale (GCS) and divided into three groups. The first included victims who received 3-4 points on the GCS during the initial assessment - 9 victims. The second group included the wounded who received 5-8 points on the GCS - 39 victims. The third group included the wounded who had 9-15 points on the GCS - 74 victims. Statistical data processing was carried out in the Statistical software EZR v. 1.61 (graphical user interface for R statistical software version 4.2.2, R Foundation for Statistical Computing, Vienna, Austria). The article presents the median (Me) and interquartile range (QI - QIII) of the values of the studied indicators.

medical stabilization trauma wounded aeromedical evacuation

Results

As a result of the conducted research, it was established that the initial assessment of victims with explosive thoraco-abdominal injury and penetrating head injuries according to the GCS had a significant effect (p<0.001) on the duration of preparation for AME and was 0 (0-0.25) in the first group days, in the second 0 (0-1) days and 1 (0-2) days in the wounded of the third group.

During the assessment of the need for artificial lung ventilation (ALV), it was established that in the victims of the first and second studied groups (GCS 3-4 and 5-8 points), it was 100%, in the victims of the third group, the need for ventilator was 58.1%. A significant difference (p<0.001) was established between the need for mechanical ventilation in the victims of the first and third groups and in the victims of the second and third studied groups.

Regarding the need for sedation at the stage of aeromedical evacuation, it was established that the need was 100% for the victims of the first and second studied groups, and 56.8% for the victims of the 3rd group. Calculation data are given in Table 1.

Table 1

The need for mechanical ventilation and sedation in the studied groups

Notes: Xi-square test was used for the analysis, a posteriori comparison were carried out according to Fisher's exact test, taking into account the Bonferroni correction:

1 - the difference from the GCS group 3-4 is statistically significant, p<0.05; 2 - the difference from the GCS 5-8 group is statistically significant, p<0.05; 3 - the difference from the GCS 9-15 group is statistically significant, p<0.05.

Dependence on oxygen support (FiO2) in the victims was 100 (87.5-100) % FiO2 in the first group, 50 (50-100) % FiO2 and 50 (21 -50) % FiO2 in the second study group. A significant difference (p<0.001) was established between the need for oxygen in the victims of the first and third groups and in the victims of the second and third studied groups.

Conclusions

Victims who received 3 to 8 points during the initial neurological evaluation according to the SHKG showed a significantly higher (p<0.001) need for intensive therapy measures at the stage of stabilization and aeromedical evacuation.

References

1. Bryden, D.W., Tilghman, J.I., & Hinds, S.R. (2019). Blast-related traumatic brain injury: current concepts and research considerations. Journal of experimental neuroscience, 13, 1179069519872213.

2. Marsh, J.L., & Bentil, S.A. (2021). Cerebrospinal fluid cavitation as a mechanism of blast- induced traumatic brain injury: a review of current debates, methods, and findings. Frontiers in neurology, 12, 626393.

3. Ashworth, E.R., Baxter, D., Gibb, I.E. (2022). Blast Traumatic Brain Injury. In: Bull, A.M.J.,

4. Clasper, J., Mahoney, P.F. (eds) Blast Injury Science and Engineering. Springer, Cham.

5. Shackelford, S.A., del Junco, D.J., Reade, M.C., Bell, R., Becker, T., Gurney, J., McCafferty, R., & Marion, D.W. (2018). Association of time to craniectomy with survival in patients with severe combat-related brain injury, Neurosurgical Focus FOC, 45(6), E2.

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