| Autor: |
Mendez J; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX., Jonas RB; University Hospital at University of Texas Health San Antonio, San Antonio, TX., Barry L; University Hospital at University of Texas Health San Antonio, San Antonio, TX., Urban S; University of Colorado, Denver, CO., Cheng AC; Vanderbilt University Medical Center, Nashville, TN., Aden JK; Brooke Army Medical Center, JBSA Fort Sam Houston, TX., Bynum J; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX., Fisher AD; University of New Mexico, Albuquerque, NM; and Texas National Guard, Austin, TX., Shackelford SA; US Air Force Academy, Colorado Springs, CO., Jenkins DH; University Hospital at University of Texas Health San Antonio, San Antonio, TX., Gurney JM; Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Joint Trauma System, JBSA Fort Sam Houston, TX., Bebarta VS; University of Colorado, Denver, CO., Cap AP; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Uniformed Services University of the Health Sciences, Bethesda, MD., Rizzo JA; Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Uniformed Services University of the Health Sciences, Bethesda, MD., Wright FL; University of Colorado, Denver, CO., Nicholson SE; University Hospital at University of Texas Health San Antonio, San Antonio, TX., Schauer SG; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Uniformed Services University of the Health Sciences, Bethesda, MD. |
| Abstrakt: |
Major trauma frequently occurs in the deployed, combat setting and is especially applicable in the recent conflicts with explosives dominating the combat wounded. In future near-peer conflicts, we will likely face even more profound weapons including mortars and artillery. As such, the number of severely wounded will likely increase. Hypocalcemia frequently occurs after blood transfusions, secondary to the preservatives in the blood products; however, recent data suggests major trauma in and of itself is a risk factor for hypocalcemia. Calcium is a major ion involved in heart contractility; thus, hypocalcemia can lead to poor contractility. Smaller studies have linked hypocalcemia to worse outcomes, but it remains unclear what causes hypocalcemia and if intervening could potentially save lives. The objective of this study is to determine the incidence of hypocalcemia on hospital arrival and the association with survival. We are seeking to address the following scientific questions, (1) Is hypocalcemia present following traumatic injury prior to transfusion during resuscitation? (2) Does hypocalcemia influence the amount of blood products transfused? (3) To what extent is hypocalcemia further exacerbated by transfusion? (4) What is the relationship between hypocalcemia following traumatic injury and mortality? We will conduct a multicenter, prospective, observational study. We will gather ionized calcium levels at 0, 3, 6, 12, 18, and 24 hours as part of scheduled calcium measurements. This will ensure we have accurate data to assess the early and late effects of hypocalcemia throughout the course of resuscitation and hemorrhage control. These data will be captured by a trained study team at every site. Our findings will inform clinical practice guidelines and optimize the care delivered in the combat and civilian trauma setting. We are seeking 391 patients with complete data to meet our a priori inclusion criteria. Our study will have major immediate short-term findings including risk prediction modeling to assess who is at risk for hypocalcemia, data assessing interventions associated with the incidence of hypocalcemia, and outcome data including mortality and its link to early hypocalcemia. |
