Bundles of care for resuscitation from hemorrhagic shock and severe brain injury in trauma patients – Translating knowledge into practice

Shahid Shafi, Ashley W. Collinsworth, Kathleen M. Richter, Hasan B. Alam, Lance B. Becker, Ross Bullock, James M. Ecklund, John Gallagher, Raj Gandhi, Elliott R. Haut, Zachary L. Hickman, Heidi Hotz, James McCarthy, Alex B. Valadka, John Weigelt, John B. Holcomb

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Hemorrhagic shock and traumatic brain injury (TBI) are the 2 leading causes of death after injuries. Evidence-based practice guidelines for managing patients with these conditions have been developed, but their adoption remains suboptimal. Bundles of care for other conditions have been shown to improve compliance with evidence-based practices and patient outcomes. We sought to develop evidence-based bundles of care for early management of hemorrhagic shock and severe TBI. METHODS: We conducted a literature review to identify current treatment recommendations and supporting evidence for hemorrhagic shock and severe TBI. A multispecialty panel of 14 experienced surgeons, physicians, nurses and a former trauma patient reviewed the recommendations. The Delphi method was used to reach consensus. RESULTS: After an extensive literature review and three rounds of the Delphi process, the panel recommended 5 interventions for managing each condition. The bundle for resuscitation from hemorrhagic shock include: 1) Activate massive transfusion protocol; 2) Measure lactate or base deficit upon arrival; 3) Transfuse packed red blood cells, plasma, and platelets in a 1:1:1 ratio; 4) Measure coagulopathy using viscoelastic methods upon arrival; and 5) Do not use large volume crystalloid resuscitation. The bundle for early management of severe TBI included: 1) Avoid and treat hypoxia; 2) Avoid and treat hypotension; 3) Avoid excessive hyperventilation; 4) Evaluate and treat intracranial hypertension; and 5) Do not use steroids. CONCLUSIONS: We have proposed 2 evidence-based bundles of care for the early management of injured patients presenting with hemorrhagic shock and severe TBI. Further studies are needed to assess implementation of these bundles and their impact on patient outcomes. LEVEL OF EVIDENCE: Level III (Therapeutic/Care Management)

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Jul 6 2016

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Patient Care Bundles
Hemorrhagic Shock
Resuscitation
Brain Injuries
Wounds and Injuries
Evidence-Based Practice
Intracranial Hypertension
Hyperventilation
Practice Guidelines
Hypotension
Cause of Death
Lactic Acid
Blood Platelets
Erythrocytes
Steroids
Nurses
Traumatic Brain Injury
Physicians
Therapeutics

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Bundles of care for resuscitation from hemorrhagic shock and severe brain injury in trauma patients – Translating knowledge into practice. / Shafi, Shahid; Collinsworth, Ashley W.; Richter, Kathleen M.; Alam, Hasan B.; Becker, Lance B.; Bullock, Ross; Ecklund, James M.; Gallagher, John; Gandhi, Raj; Haut, Elliott R.; Hickman, Zachary L.; Hotz, Heidi; McCarthy, James; Valadka, Alex B.; Weigelt, John; Holcomb, John B.

In: Journal of Trauma and Acute Care Surgery, 06.07.2016.

Research output: Contribution to journalArticle

Shafi, S, Collinsworth, AW, Richter, KM, Alam, HB, Becker, LB, Bullock, R, Ecklund, JM, Gallagher, J, Gandhi, R, Haut, ER, Hickman, ZL, Hotz, H, McCarthy, J, Valadka, AB, Weigelt, J & Holcomb, JB 2016, 'Bundles of care for resuscitation from hemorrhagic shock and severe brain injury in trauma patients – Translating knowledge into practice', Journal of Trauma and Acute Care Surgery. https://doi.org/10.1097/TA.0000000000001161
Shafi, Shahid ; Collinsworth, Ashley W. ; Richter, Kathleen M. ; Alam, Hasan B. ; Becker, Lance B. ; Bullock, Ross ; Ecklund, James M. ; Gallagher, John ; Gandhi, Raj ; Haut, Elliott R. ; Hickman, Zachary L. ; Hotz, Heidi ; McCarthy, James ; Valadka, Alex B. ; Weigelt, John ; Holcomb, John B. / Bundles of care for resuscitation from hemorrhagic shock and severe brain injury in trauma patients – Translating knowledge into practice. In: Journal of Trauma and Acute Care Surgery. 2016.
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abstract = "BACKGROUND: Hemorrhagic shock and traumatic brain injury (TBI) are the 2 leading causes of death after injuries. Evidence-based practice guidelines for managing patients with these conditions have been developed, but their adoption remains suboptimal. Bundles of care for other conditions have been shown to improve compliance with evidence-based practices and patient outcomes. We sought to develop evidence-based bundles of care for early management of hemorrhagic shock and severe TBI. METHODS: We conducted a literature review to identify current treatment recommendations and supporting evidence for hemorrhagic shock and severe TBI. A multispecialty panel of 14 experienced surgeons, physicians, nurses and a former trauma patient reviewed the recommendations. The Delphi method was used to reach consensus. RESULTS: After an extensive literature review and three rounds of the Delphi process, the panel recommended 5 interventions for managing each condition. The bundle for resuscitation from hemorrhagic shock include: 1) Activate massive transfusion protocol; 2) Measure lactate or base deficit upon arrival; 3) Transfuse packed red blood cells, plasma, and platelets in a 1:1:1 ratio; 4) Measure coagulopathy using viscoelastic methods upon arrival; and 5) Do not use large volume crystalloid resuscitation. The bundle for early management of severe TBI included: 1) Avoid and treat hypoxia; 2) Avoid and treat hypotension; 3) Avoid excessive hyperventilation; 4) Evaluate and treat intracranial hypertension; and 5) Do not use steroids. CONCLUSIONS: We have proposed 2 evidence-based bundles of care for the early management of injured patients presenting with hemorrhagic shock and severe TBI. Further studies are needed to assess implementation of these bundles and their impact on patient outcomes. LEVEL OF EVIDENCE: Level III (Therapeutic/Care Management)",
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AU - Shafi, Shahid

AU - Collinsworth, Ashley W.

AU - Richter, Kathleen M.

AU - Alam, Hasan B.

AU - Becker, Lance B.

AU - Bullock, Ross

AU - Ecklund, James M.

AU - Gallagher, John

AU - Gandhi, Raj

AU - Haut, Elliott R.

AU - Hickman, Zachary L.

AU - Hotz, Heidi

AU - McCarthy, James

AU - Valadka, Alex B.

AU - Weigelt, John

AU - Holcomb, John B.

PY - 2016/7/6

Y1 - 2016/7/6

N2 - BACKGROUND: Hemorrhagic shock and traumatic brain injury (TBI) are the 2 leading causes of death after injuries. Evidence-based practice guidelines for managing patients with these conditions have been developed, but their adoption remains suboptimal. Bundles of care for other conditions have been shown to improve compliance with evidence-based practices and patient outcomes. We sought to develop evidence-based bundles of care for early management of hemorrhagic shock and severe TBI. METHODS: We conducted a literature review to identify current treatment recommendations and supporting evidence for hemorrhagic shock and severe TBI. A multispecialty panel of 14 experienced surgeons, physicians, nurses and a former trauma patient reviewed the recommendations. The Delphi method was used to reach consensus. RESULTS: After an extensive literature review and three rounds of the Delphi process, the panel recommended 5 interventions for managing each condition. The bundle for resuscitation from hemorrhagic shock include: 1) Activate massive transfusion protocol; 2) Measure lactate or base deficit upon arrival; 3) Transfuse packed red blood cells, plasma, and platelets in a 1:1:1 ratio; 4) Measure coagulopathy using viscoelastic methods upon arrival; and 5) Do not use large volume crystalloid resuscitation. The bundle for early management of severe TBI included: 1) Avoid and treat hypoxia; 2) Avoid and treat hypotension; 3) Avoid excessive hyperventilation; 4) Evaluate and treat intracranial hypertension; and 5) Do not use steroids. CONCLUSIONS: We have proposed 2 evidence-based bundles of care for the early management of injured patients presenting with hemorrhagic shock and severe TBI. Further studies are needed to assess implementation of these bundles and their impact on patient outcomes. LEVEL OF EVIDENCE: Level III (Therapeutic/Care Management)

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