Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA.
Department of Surgery, University of Alabama Birmingham, Birmingham, AL 35233, USA.
Mil Med. 2024 Aug 19;189(Suppl 3):190-195. doi: 10.1093/milmed/usae072.
The association between hypothermia, coagulopathy, and acidosis in trauma is well described. Hypothermia mitigation starts in the prehospital setting; however, it is often a secondary focus after other life-saving interventions. The deployed environment further compounds the problem due to prolonged evacuation times in rotary wing aircraft, resource limitations, and competing priorities. This analysis evaluates hypothermia in combat casualties and the relationship to resuscitation strategy with blood products.
Using the data from the Department of Defense Joint Trauma Registry from 2003 to 2021, a retrospective analysis was conducted on adult trauma patients. Inclusion criteria was arrival at the first military treatment facility (MTF) hypothermic (<95ºF). Study variables included: mortality, year, demographics, battle vs non-battle injury, mechanism, theater of operation, vitals, and labs. Subgroup analysis was performed on severely injured (15 < ISS < 75) hypothermic trauma patients resuscitated with whole blood (WB) vs only component therapy.
Of the 69,364 patients included, 908 (1.3%) arrived hypothermic; the vast majority of whom (N = 847, 93.3%) arrived mildly hypothermic (90-94.9°F). Overall mortality rate was 14.8%. Rates of hypothermia varied by year from 0.7% in 2003 to 3.9% in 2014 (P <0.005). On subgroup analysis, mortality rates were similar between patients resuscitated with WB vs only component therapy; though base deficit values were higher in the WB cohort (-10 vs -6, P < 0.001).
Despite nearly 20 years of combat operations, hypothermia continues to be a challenge in military trauma and is associated with a high mortality rate. Mortality was similar between hypothermic trauma patients resuscitated with WB vs component therapy, despite greater physiologic derangements on arrival in patients who received WB. As the military has the potential to conduct missions in environments where the risk of hypothermia is high, further research into hypothermia mitigation techniques and resuscitation strategies in the deployed setting is warranted.
创伤后低温、凝血功能障碍和酸中毒之间的关系已得到充分描述。低温缓解始于院前环境；然而，在其他挽救生命的干预措施之后，这往往是次要关注点。部署环境由于在旋转翼飞机上的撤离时间延长、资源限制和竞争优先级，进一步加剧了这个问题。本分析评估了战斗伤员中的低温，并评估了与血液制品复苏策略的关系。
使用 2003 年至 2021 年期间国防部联合创伤登记处的数据，对成年创伤患者进行回顾性分析。纳入标准为到达第一个军事治疗设施（MTF）时体温过低（<95°F）。研究变量包括：死亡率、年份、人口统计学、战斗与非战斗损伤、机制、战区、生命体征和实验室检查。对严重损伤（ISS 15< <75）的低温创伤患者进行亚组分析，这些患者接受全血（WB）复苏与仅成分治疗。
在纳入的 69364 名患者中，有 908 名（1.3%）到达时体温过低；其中绝大多数（N=847，93.3%）到达时轻度低温（90-94.9°F）。总体死亡率为 14.8%。低温发生率因年份而异，2003 年为 0.7%，2014 年为 3.9%（P<0.005）。在亚组分析中，接受 WB 复苏与仅成分治疗的患者死亡率相似；尽管 WB 组的基础缺陷值更高（-10 对-6，P<0.001）。
尽管近 20 年的作战行动，低温仍然是军事创伤的一个挑战，并且与高死亡率相关。在接受 WB 复苏的低温创伤患者与接受成分治疗的患者之间，死亡率相似，尽管接受 WB 的患者入院时生理紊乱更大。由于军队有可能在低温风险较高的环境中执行任务，因此有必要对部署环境中的低温缓解技术和复苏策略进行进一步研究。
