Evaluating the effectiveness of blood loss correction in victims with penetrating blast injuries at the stage of stabilization and preparation for aeromedical evacuation

Abstract

Management strategies in patients with hemorrhagic shock are still of scientific and clinical interest, as improved approaches to rapid and effective stabilization will lead to increased survival outcomes. The purpose of the study: to compare the effectiveness of blood loss correction in victims with penetrating blast injuries at the stage of stabilization and preparation for aeromedical evacuation. Materials and methods. The study retrospectively analyzed the medical records of 122 patients who were injured while performing combat missions in the area of the Anti-Terrorist Operation/Joint Forces Operation for 3 years (2016–2019). Victims with combat trauma were divided into three groups. All injured servicemen were evacuated by helicopters from field hospitals in order to transfer them to the stage of providing specialized medical care. The degree of shock was determined using Allgower’s method of arithmetic calculation of the shock index and according to the data of laboratory studies. Fluid therapy at the stage of stabilization was carried out with colloid and crystalloid solutions, which, in case of a massive blood loss, were supplemented by transfusion of the fresh frozen plasma and packed red blood cells according to the traditional scheme of replenishing blood loss at the stage of provi­ding medical assistance. Results. As a result of stabilization measures, a decrease in heart rate by 13.5 % (95% confidence interval (CI) 11.2–15.7 %) was observed at the stage of preparation for aeromedical evacuation. An increase in systolic blood pressure was detected in the studied groups. The average blood pressure in victims with blast thoraco-abdominal injuries during hospitalization was 81.5 (71–93) mmHg, and after stabilization measures, it increased to 88 (82–93) mmHg. A significant difference was found between the groups of patients with blast trauma and traumatic brain injuries at the stages of the study (p < 0.05). As a result of stabilization measures, it was possible to reduce shock index in the studied groups by 23.7 % (95% CI 19.2–29.5 %). Conclusions. The use of a set of stabilization measures in patients with penetrating blast injuries at the stage of hospitalization made it possible to improve vital functions by 23.7 % (95% CI 19.2–29.5 %), and to reduce shock index.