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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
8/18/2019 2. Military Trauma Research Gaps Final
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.
8/18/2019 2. Military Trauma Research Gaps Final
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
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Military Trauma Research
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
8/18/2019 2. Military Trauma Research Gaps Final
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Military Trauma Research
Gaps
• /emorrhage• Treatments to enhance o0ygen deliery and
per(usion
• E1uipment and procedures (or e((ectie (luid
resuscitation o( casualties
• Enhanced * optimi2ed resuscitation (luids
8/18/2019 2. Military Trauma Research Gaps Final
6/22
O3
4on+#uria.le Etiology
Eastridge et al, J Trauma 2011
8/18/2019 2. Military Trauma Research Gaps Final
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O3
'otentially #uria.le Etiology
Eastridge et al, J Trauma 2011
8/18/2019 2. Military Trauma Research Gaps Final
8/22
O3 5'otentially #uria.le6
/emorrhage !ocus
Eastridge et al, J Trauma 2011
8/18/2019 2. Military Trauma Research Gaps Final
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Military Trauma Research
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
8/18/2019 2. Military Trauma Research Gaps Final
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Blood * Coagulation
•
4ear /ori2on – Transition o( !ree2e+ried
'lasma and Cryo+'resered'latelets to "dancedeelopment 5clinical trials6
• Current !ocus "reas – $nderstanding .asic
mechanisms o( trauma+induced coagulopathy
– eeloping improedplatelet storage systems
– eeloping .lood productpathogen reductiontechnologies
8/18/2019 2. Military Trauma Research Gaps Final
11/22
Military Trauma Research
Gaps
Orthopaedic Trauma
• /ealing o( segmental .one de(ects
• 'reention o( heterotopic ossi(ication
• /ealing o( massie so(t tissue de(ects
• Tissue ia.ility assessment and wound
irrigation * de.ridement technologies
• 3ound n(ection * n(ection Control
11
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Military Trauma Research
Gaps
Massie #o(t Tissue n)ury
• rugs, deices, or noel surgical
techni1ues to decontaminate, de.ride,
protect, and sta.ili2e hard and so(ttissue wounds to mitigate secondary
tissue damage
• Replacement or regeneration o( lost
tissues * organs
12
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E0tremity Trauma &
Regeneratie Medicine
• e(ining the in)ury patternsand resulting (unctionaloutcomes
• Open (ractures• #o(t tissue de(ects 5muscle and
nere6• 3ound irrigation and de.ridement
• Current !ocus "reas – "nimal modeling o( traumatic in)ury
• #egmental de(ects• 3ound contamination and in(ection
– Muscle * .one regeneration – eliery o( autologous stem cells to
treat de(ects
8/18/2019 2. Military Trauma Research Gaps Final
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Battlefield Injury
Face 7%Face 7%
Eye 3%Eye 3%
Head/Neck 2%Head/Neck 2%
Head/Neck
27%
Head/Neck
27%
!est "%!est "%
#$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%
8/18/2019 2. Military Trauma Research Gaps Final
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Military Trauma Research
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"
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Military Trauma Research
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'
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Military Trauma Research
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
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'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
8/18/2019 2. Military Trauma Research Gaps Final
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Military Trauma Research
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
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Military Trauma Research
Gaps
Burn
• -ia.le transitional s7in products to
austere enironments
• 'rotecting s7in gra(ts (rom immunerecognition
• Replacement and regeneration o(
s7in
20
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Military Trauma Research
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
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22/22
8uestions9