Objectives of resuscitation of a critically injured person during pre-hospital stage before evacuation to a higher level of care under active combat conditions

Background. Timely and high-quality medical evacuation improves the survival of a patient with combat surgical trauma. Objective: to improve the goals of resuscitation of the wounded people before evacuation from pre-hospital medical facilities under active combat conditions. Materials and ­methods. The retrospective study included 229 emergency patients who were transported from prehospital secondary care to tertiary care medical facilities. Results. Among the evacuees with trauma, 96.5 % had combat surgical trauma (n = 216). In terms of the extent of traumatization, 93 % of patients were characterized as those having severe trauma, with a New Injury Severity Score of > 25 points. Moreover, in 70 % (n = 151) of the cases, the injuries resulted in hemorrhagic shock and the need for blood transfusion. However, in 29 % (n = 44) of the cases, after appropriate replacement therapy, there was a need to use vasoactive drugs. Before transporting critically injured patients, we assessed resuscitation by the main parameters: heart rate (HR), systolic blood pressure (SBP), oxygen saturation (SaO2), hemoglobin level, and urine output. Deviations from resuscitation goals were identified in 86 patients before the start of evacuation from Role 2 to Role 3. Deviations according to three criteria were observed in 2 wounded (2.3 %), according to two criteria — in 19 wounded (22 %), and according to one criterion — in the other (75.7 %). During evacuation, we continued intensive care; as a result, after evacuation, HR was 114 (105; 120) bpm, the median value decreased by 12 (p = 0.01). And SBP increased by an average of 10.5 mmHg after transportation among patients with a violation according to this criterion (p > 0.05). Conclusions. HR 50–120 bpm, SBP > 90 mmHg (mean blood pressure > 60 mmHg), in patients with traumatic brain injury — above 110 mmHg, SaO2 > 92 %, required FiO2 < 50 %, temperature > 35 °C, urine output > 50 ml/h, hemoglobin > 80 g/l, diameter of vena cava inferior 15–21 mm are optimal resuscitation goals when transporting a critically injured person from Role 1/2 to Role 3. In the future, the study aims to develop algorithms for the management of injured patients during evacuation depending on combinations of deviations in resuscitation parameters.