Explore the vast range of titles available.

Military anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations. This study aimed to describe and analyze French anesthetic activity in a deployed military setting. Between October 2015 and February 2018, all patients managed by Sainte-Anne Military Hospital anesthesiologists deployed in mission were included. Anesthesia management was described and compared with the same surgical procedures in France performed by the same anesthesia team (hernia repair, lower and upper limb surgeries). Demographics, type of surgical procedure, and surgical activity were also described. The primary endpoint was to describe anesthesia management during the deployment of forward surgical teams (FST). The secondary endpoint was to compare anesthesia modalities during FST deployment with those usually used in a military teaching hospital. During the study period, 1547 instances of anesthesia were performed by 11 anesthesiologists during 20 missions, totaling 1237 days of deployment in nine different theaters. The majority consisted of regional anesthesia, alone (43.5%) or associated with general anesthesia (21%). Compared with France, there was a statistically significant increase in the use of regional anesthesia in hernia repair, lower and upper limb surgeries during deployment. The majority of patients were civilians as part of medical support to populations. In the context of an austere environment, the use of regional anesthesia techniques predominated when possible. These results show that the training of military anesthetists must be complete, including anesthesia, intensive care, pediatrics, and regional anesthesia.

Background Emerging evidence suggests that the reallocation of health care resources during the COVID-19 pandemic negatively impacts health care system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. Methods This retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers contributing to the TraumaBase® registry during the first wave of the SARS-CoV-2 pandemic in France. This COVID-19 trauma cohort was compared to historical cohorts (2017–2019). Results Over a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017–2019, 4448 patients). Trauma patient demographics changed substantially during the pandemic especially during the lockdown period, with an observed reduction in both the absolute numbers and proportion exposed to road traffic accidents and subsequently admitted to traumacenters (348 annually 2017–2019 [55.4% of trauma admissions] vs 143 [36.8%] in 2020 p  < 0.005). The in-hospital observed mortality and predicted mortality during the pandemic period were not different compared to the non-pandemic years. Conclusions During this first wave of COVID-19 in France, and more specifically during lockdown there was a significant reduction of patients admitted to designated trauma centers. Despite the reallocation and reorganization of medical resources this reduction prevented the saturation of the trauma rescue chain and has allowed maintaining a high quality of care for trauma patients.

Introduction The rate of potentially preventable deaths (PPD) and preventable deaths (PD) can reach more than 20% of overall trauma mortality. Bleeding is the leading cause of preventable mortality. The aim of our study is to define the independent factors of preventable or potentially preventable mortality in our mature trauma system. Materials and methods We conducted a single-center retrospective study in the Sainte Anne Military Teaching Hospital, Toulon, France, including all severe trauma patients admitted to our trauma center and discharged alive as well as all severe trauma patients who died with a death considered preventable or potentially preventable from January 2013 to December 2020. We matched the two groups using a propensity score and searched for independent factors using a generalized linear model. Results 846 patients were included and analyzed. After matching, our cohort consisted of 245 patients in the survivor group and 49 patients in the preventable deaths group. Pre-hospital delays (73 min vs 54 min P  = 0.003) as well as delays before incision in the operating room (80 min vs 52 min P  < 0.001) were significantly longer in the PD group. These delays were independent factors of preventable mortality OR 10.35 (95% CI [3.44–31.11] P  < 0.001) and OR 37.53 (95% CI [8.51–165.46] P  < 0.001) as well as pelvic trauma OR 6.20 (95% CI [1.53–25.20] P  = 0.011). Conclusion Delays in pre-hospital care, delays in access to the operating room from arrival at the trauma center, and pelvic injuries are independent factors associated with an increased risk of preventable mortality in trauma.

Background Traumatic rhabdomyolysis (RM) is common and associated with the development of acute kidney injury and potentially with other organ dysfunctions. Thus, RM may increase the risk of death. The primary objective was to assess the effect of severe RM (Creatine Kinase [CK] > 5000 U/L) on 30-day mortality in trauma patients using a causal inference approach. Methods In this multicenter cohort study conducted in France using a national major trauma registry (Traumabase) between January 1, 2012, and July 1, 2023, all patients admitted to a participating major trauma center hospitalized in intensive care unit (ICU) and with CK measurement were included. Confounding variables for both 30-day mortality and exposure were used to establish a propensity score. A doubly robust approach with inverse treatment weighting enabled the calculation of the average treatment effect on the treated (ATT). Analyses were performed in the overall cohort as well as in two subgroups: hemorrhagic shock subgroup (HS) and traumatic brain injury subgroup (TBI). Sensitivity analyses were conducted. Results Among the 8592 patients included, 1544 (18.0%) had severe RM. They were predominantly males (78.6%) with median [IQR] age of 41 [27–58] years and severely injured (ISS 20 [13 – 29]) mainly from blunt trauma (90.8%). In the entire cohort, the ATT, expressed as a risk difference, was 0.073 [-0.054 to 0.200]. Considering the 1311 patients in the HS subgroup, the ATT was 0.039 [0.014 to 0.063]. As in the overall cohort, there was no effect on mortality in the TBI subgroup. Severe RM was associated with greater severity of trauma and more complications (whether related to renal function or not) during the ICU stay. Mortality due to multiorgan failure (39.9% vs 12.4%) or septic shock (2.6% vs 0.8%) was more frequent among patients with severe RM. Conclusions Severe RM was not associated with 30-day mortality considering the overall cohort. However, it was associated with a 4.0% increase in 30-day mortality among patients with concurrent hemorrhagic shock. Severe RM plays a significant role in ICU morbidity.

Background Progressive hemorrhagic injury (PHI) is common in patients with severe traumatic brain injury (TBI) and is associated with poor outcomes. TBI-associated coagulopathy is frequent and has been described as risk factor for PHI. This coagulopathy is a dynamic process involving hypercoagulable and hypocoagulable states either one after the other either concomitant. Fibrin monomers (FMs) are a direct marker of thrombin action and thus reflect coagulation activation. This study sought to determine the ability of FM to predict PHI after severe TBI. Methods We conducted a prospective, observational study including all severe TBI patients admitted in the trauma center. Between September 2011 and September 2016, we enrolled patients with severe TBI into the derivation cohort. Between October 2016 and December 2018, we recruited the validation cohort on the same basis. Study protocol included FM measurements and standard coagulation test at admission and two computed tomography (CT) scans (upon arrival and at least 6 h thereafter). A PHI was defined by an increment in size of initial lesion (25% or more) or the development of a new hemorrhage in the follow-up CT scan. Multivariate logistic regression analysis was applied to identify predictors of PHI. Results Overall, 106 patients were included in the derivation cohort. Fifty-four (50.9%) experienced PHI. FM values were higher in these patients (151 [136.8–151] vs. 120.5 [53.3–151], p  < 0.0001). The ROC curve demonstrated that FM had a fair accuracy to predict the occurrence of PHI with an area under curve of 0.7 (95% CI [0.6–0.79]). The best threshold was determined at 131.7 μg/ml. In the validation cohort of 54 patients, this threshold had a negative predictive value of 94% (95% CI [71–100]) and a positive predictive value of 49% (95% CI [32–66]). The multivariate logistic regression analysis identified 2 parameters associated with PHI: FM ≥ 131.7 (OR 6.8; 95% CI [2.8–18.1]) and Marshall category (OR 1.7; 95% CI [1.3–2.2]). Coagulopathy was not associated with PHI (OR 1.3; 95% CI [0.5–3.0]). The proportion of patients with an unfavorable functional neurologic outcome at 6-months follow-up was higher in patients with positive FM: 59 (62.1%) versus 16 (29.1%), p  < 0.0001. Conclusions FM levels at admission had a fair accuracy to predict PHI in patients with severe TBI. FM values ≥ 131.7 μg/ml are independently associated with the occurrence of PHI.

The management of war casualties has evolved significantly. Tactical tourniquets, early surgical haemostasis and massive transfusion protocols have all contributed to a significant decrease in war casualties’ mortality. Large scale combat scenarios pose new and major challenges, as the volume of casualties is predicted to exceed available resources. Combat Medical Early Warning Systems (CMEWS) and wearable biosensors could present promising solutions in this context. An Early Warning System consists of three key components: data collection of vital signs, analysis through an Early Warning Score and a corresponding medical response. Biosensors, on the other hand, enable continuous monitoring of physiological parameters. Their miniaturisation, connectivity and reliability make them promising tools, though challenges such as accuracy, cost and data integration remain. Integrated CMEWS, combining biosensors with automated decision-making algorithms, could revolutionise the management of war casualties. These systems would assist in the early identification of severe war casualties and triage, assisting health services in casualty flow management. They have the potential for providing a shared, real-time overview of casualties’ status for all healthcare providers. Additionally, the integration of these systems into the battlefield would facilitate improved coordination across medical and command structures, enhancing patient management even in remote or high-risk environments. However, the adoption of integrated CMEWS and biosensors faces challenges, including data security concerns, infrastructure limitations and the need for significant investment and training. Despite these hurdles, their potential to enhance casualty care, particularly in high-intensity conflict settings, is evident and could transform both military and civilian emergency medical care.

Background Evidence increases to suggest that the reallocation of health care resources during considerable the COVID-19 pandemic impacts considerably any health system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. Methods This retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers participating to the TraumaBase® registry in France during the first wave of the SARS-CoV-2 pandemic in France. Results Over a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017-2019, 4448 patients). Patient demographics changed substantially during the pandemic and more specifically during the lockdown period specially with a reduction in both absolute numbers admitted and the proportion of road traffic accidents (348 annually 2017-2019 [55.4 % of trauma admissions] vs 143 [36.8 %] in 2020 p<0.005). Mortality during the pandemic period and the difference between predicted and observed mortality was not different compared to the non-pandemic years. Conclusions During this first wave of COVID-19 in France, management of trauma patients admitted to regional Traumacenters was not significantly altered, despite medical resources being reallocated and reorganized. Mortality as well as prehospital and in hospital care remained stable throughout the period of the first pandemic wave despite a massive increase in demand for acute care beds.