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Detection and Management of Non-Compressible Hemorrhage by Vena Cava Ultrasonography

Principal Investigator:  Jay Doucet, MD Lead Institution: University of California at San Diego (UCSD) Participating Sites: University of Utah, Emory University, and University of Maryland School of Medicine This was a prospective, observational clinical trial of major trauma victims at four academic trauma centers using bedside ultrasound to identify patients with hypovolemia as determined by inferior vena cava (IVC) collapsibility. Patients with significant IVC collapsibility were enrolled. Participants were stratified at a second ultrasound IVC exam 30-40 minutes after admission by response or non-response to an intravenous fluid challenge. The objective was to demonstrate whether non-responder participants had significant shock physiology. This study provides an opportunity to demonstrate the ability of handheld ultrasound devices to detect and monitor hemorrhagic shock in initial trauma care and in the ICU. This technique may predict those patients who will require transfusions, surgery, or angiographic embolization. It may improve triage of major trauma victims and, thereby, avoid therapeutic delays and complications. This study was completed with funding from the Joint Warfighter Medical Research Program.

Publications

Faulconer ER, Branco BC, Loja MN, Grayson K, Sampson J, Fabian TC, Holcomb JB, Scalea T, Skarupa D, Inaba K, Poulin N, Rasmussen TE, Dubose JJ. Use of open and endovascular surgical techniques to manage vascular injuries in the trauma setting: A review of the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial registry.
J Trauma Acute Care Surg. 2018 Mar;84(3):411-417. doi: 10.1097/TA.0000000000001776.

Loja MN, Galante JM, Humphries M, Savage S, Fabian T, Scalea T, Holcomb JB, Poulin N, DuBose J, Rasmussen TE; AAST PROOVIT Study Group. Systemic anticoagulation in the setting of vascular extremity trauma.
Injury. 2017 Sep;48(9):1911-1916. doi: 10.1016/j.injury.2017.03.020. Epub 2017 Mar 20.

Loja MN, Sammann A, DuBose J, Li CS, Liu Y, Savage S, Scalea T, Holcomb JB, Rasmussen TE, Knudson MM; AAST PROOVIT Study Group. The mangled extremity score and amputation: Time for a revision.
J Trauma Acute Care Surg. 2017 Mar;82(3):518-523. doi: 10.1097/TA.0000000000001339.
Select item 257571045.

DuBose JJ, Savage SA, Fabian TC, Menaker J, Scalea T, Holcomb JB, Skarupa D, Poulin N, Chourliaras K, Inaba K, Rasmussen TE; AAST PROOVIT Study Group. The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis, management, and outcomes.
J Trauma Acute Care Surg. 2015 Feb;78(2):215-22; discussion 222-3. doi: 10.1097/TA.0000000000000520. Erratum in: J Trauma Acute Care Surg. 2015 Mar;78(3):657.