By Elaine Wilson, Special to American
Forces Press Service
FORT SAM HOUSTON, Texas -- A new lifesaving standard of
care has garnered the U.S. Army Institute of Surgical Research here a
prestigious recognition: invention of the year.
The innovation, called Damage Control Resuscitation of Severely
Injured Soldiers, was named one of the Army's "Top Ten Greatest
Inventions of 2007."
"The American Association for Trauma Surgeons calls this
one of the biggest improvements to trauma care in the last 10
years," said Michael Dubick, senior research pharmacologist for
the Institute of Surgical Research. The invention is aimed at saving
severely injured Soldiers with internal injuries that cannot be
compressed using a tourniquet or other device, Dubick said.
The institute focused its attention on severely injured
Soldiers after analyzing data from an autopsy study that showed 79
percent of servicemembers killed in combat died of hemorrhage, and 70
percent had an injury that couldn't be compressed.
"We needed to find a better way to stop bleeding,"
Dubick said. "In-theater, there was no solution for people with
"We believe that procedures like this one can save Soldiers
who survive beyond 10 minutes -- keep them alive long enough to
get to the hospital and to surgery."
Senior Research Pharmacologist,
Institute of Surgical Research
The innovation involves the fluid resuscitation process, in
which IV fluids and blood products are used to stabilize a patient's
physiology. The standard method is to administer IV salt solutions in
an amount that is three times the patient's blood volume. If the
patient still is bleeding, blood transfusions are given to restore
In most cases, this method is effective for wounded troops, but
for some severely injured warriors, the massive volume of fluids and
blood can create a negative effect, Dubick said.
"The body has only a finite amount of clotting
factors," he explained, "and a large volume of fluids can
dilute those clotting factors, which reduces their ability to slow
down or stop the bleeding."
Under the new standard of care, fluid resuscitation with salt
solutions is limited, which keeps the blood pressure from rising too
high and "popping" newly formed blood clots. In addition,
blood volume is restored using plasma as the primary resuscitation
fluid, along with packed red blood cells.
But rather than using the standard of four times the amount of
red blood cells to plasma, "we use a ratio of 1-to-1 of plasma to
red blood cells," Dubick said.
Dubick said early use of a clotting factor called
"rFVIIa" also has been beneficial. The factor normally is
used for hemophiliacs, but it has proven beneficial for severely
injured warriors. Other blood products, such as platelets and
"cryoprecipitate," are used as needed.
The reduction in fluids not only increases the patient's
short-term chances of survival, but also helps long-term treatment,
since "there is less fluid built up in organs, and surgeons have
a better field of operation," Dubick said.
While the innovation is gaining recognition stateside, it
already has had a striking impact in the combat theater, decreasing
the mortality rate from 65 to 17 percent.
The impact of this change in the standard of care is so
striking, Dubick said, that "some liken this standard of care to
the first time someone applied antibiotics."
The military innovation also is gaining civilian attention.
"We've met with over 26 civilian centers and are working
with 16 of them," Dubick said.
As word of the lifesaving measure begins to spread, Dubick
said, he and his fellow scientists already are looking ahead, working
with a company to produce freeze-dried plasma. In its natural state,
plasma has a limited shelf life and is subject to temperature
The scientists also would like to develop a shelf-stable
artificial blood with clotting factors that would enable medics to
provide early intervention at the site of injury, Dubick said.
"The majority of patients bleed to death in the first five
to 10 minutes," Dubick said. "We believe that procedures
like this one can save Soldiers
who survive beyond 10 minutes -- keep them alive long enough to get to
the hospital and to surgery."
The invention was the only medical innovation to make the
Army's Top Ten cut.
More information about the program is available at the Web site
U.S. Army Institute of Surgical Research http://www.usaisr.amedd.army.mil/.
(Wilson works at the Fort Sam Houston
Public Information Office.)