Citation

Kirkpatrick AW, McKee JL, Tien H, LaPorta AJ, Lavell K, Leslie T, King DR, McBeth PB, Brien S, Roberts DJ, Franciose R, Wong J, McAlistatair V, Bouchard D, Ball CG. J. Trauma Acute Care Surg. 2016; 82(2): 392-399.

Affiliation

1Canadian Forces Health Services; Departments of 2Surgery, 3Critical Care Medicine, and the 4Regional Trauma Services Foothills Medical Centre, 5University of Calgary, Calgary, Alberta; 6Innovative Trauma Care, Edmonton, Alberta; 7Sunnybrook Health Sciences Centre, Toronto, Ontario; 8Rocky Vista University School of Medicine, Colorado; 9Strategic Operations, San Diego, California; 10Flight Research Laboratory, National Research Council of Canada, Ottawa, Ontario; 11Harvard Medical School, Boston, Massachusetts; 12Royal College of Physicians and Surgeons, Ottawa, Ontario; 13Denver Health and 14Vail Valley Medical Center, Colorado;15University of Western Ontario, London, Ontario.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001310

PMID

27787439

Abstract

INTRODUCTION: Torso bleeding remains the most preventable cause of post-traumatic death worldwide. Remote Damage Control Resuscitation (RDCR) endeavours to rescue the most catastrophically injured, but has not focused on pre-hospital surgical torso haemorrhage control (HC). We examined the logistics and metrics of intra-peritoneal packing in weightlessness in Parabolic flight (0g) compared to terrestrial gravity (1g) as an extreme example of surgical RDCR.

METHODS: A surgical simulator was customized with high-fidelity intra-peritoneal anatomy, a "blood" pump and flow-meter. A standardized HC task was to explore the simulator, identify "bleeding" from a previously unknown liver injury perfused at 80 mmHg, and pack to gain hemostasis. Ten surgeons performed RDCR laparotomies onboard a research aircraft, first in 1g followed by 0g. The standardized laparotomy was sectioned into 20 second segments to conduct and facilitate parabolic flight comparisons, with "blood' pumped only during these time-segments. A maximum of 12 segments permitted for each laparotomy.

RESULTS: All 10 surgeons successfully performed HC in both 1g and 0g. There was no difference in blood loss between 1g and 0g (p=0.161) or during observation following HC (p=0.944). Compared to 1g, identification of bleeding in 0g incurred less "blood" loss (p=0.032). Overall surgeons rated their personal performance and relative difficulty of surgery in 0g as "harder" (median Likert 2/5). However, conducting all phases of HC were rated equivalent between 1 and 0g (median Likert 3/5), except for instrument control (rated slightly harder 2.75/5).

CONCLUSION: Performing laparotomies with packing of a simulated torso hemorrhage in a high-fidelity surgical simulator was feasible onboard a research aircraft in both normal and weightless conditions. Despite being subjectively "harder" most phases of operative intervention were rated equivalently, with no statistical difference in "blood" loss in weightlessness. Direct Operative control of torso hemorrhage is theoretically possible in extreme environments if logistics are provided. LEVEL OF EVIDENCE: IV.

Language: en