Long-Term Follow-Up and Amputation-Free Survival in 497 Casualties with Combat-Related Vascular Injuries and Damage-Control Resuscitation.

摘要

BACKGROUND: The effectiveness of damage-control resuscitation (DCR) has been demonstrated in recent US conflicts. Wartime casual-ties treated for hemorrhagic shock from vascular wounds were studied to report the 24-hour transfusion requirements, graft patency, and amputation-free survival for major vascular injuries. METHODS: Joint Theater Trauma Registry data from August 2006 to April 2011 (56 months) were retrospectively reviewed. Included were casualties with a vascular injury who presented to US combat support hospitals in Iraq or Afghanistan. Amputation-free survival and graft patency were determined from record and imaging review. RESULTS: The study group consisted of 497 severely wounded local national and military casualties (mean [SD] Injury Severity Score [ISS], 17 [8.5]) presenting with acidosis (pH 7.29 [0.15]), tachycardia (heart rate, 110 [29.31]), and coagulopathy (international normalized ratio, 1.6 [2.33]). Given DCR and early management of vascular injury, blood pressure, heart rate, temperature, hemoglobin, and base deficit improved promptly ( p less than 0.05) by intensive care unit admission. Transfusion requirements included packed red blood cells (15 [13] U; range, 1 70 U), fresh frozen plasma (14 [13] U; range, 1 72 U), cryoprecipitate (13 [15] U; range, 1 49 U), and platelets (8 [6] U; range, 1 36 U). Mean operative time was 232 minutes (range, 16 763 minutes). US casualties (n 111) had limb salvage attempted for 113 extremity vascular injuries (3 [2%] iliac, 33 [30%] femoral, 23 [20%] popliteal, 13 [12%] tibial, 33 [30%] brachial, 4 [3%] ulnar, and 4 [(3%] radial). In this sub- group, 28 (25%) were revascularized by a primary repair or end anastomosis, 80 (71%) were revascularized by saphenovenous grafts, and 5 (4%) were revascularized by prosthetic grafts.