Page 113 - JSOM Fall 2022

2022 Scientific Assembly
Research Award Winners and Presentations

feasible and its re­introduction to pre­hospital trauma guide­
POSTER RESEARCH AWARD
lines should be considered, mainly as a bridge for other mea­
Pressure Points, A Lifesaving Practice Forsaken in Vain, sures to be applied while preserving precious blood in the first
Findings from the Pressure Points Study critical moments following injury.
MAJ Regina Pikman Gavriely, MD1,2; SSG Yotam Lior, MD
PhD2; CPT Shaul Gelikas, MD MBA1; MAJ Shiran Levy,
MD1,3; COL Avi Benov, MD MHA4,5; MAJ Alon Ahimor, PODIUM RESEARCH
MD1; MAJ Guy Avital, MD1,2 PRESENTATION AWARD
1. The Trauma and Combat Medicine Branch, Surgeon Gen­ Hyperoxia Is Associated With a Greater Risk for
eral’s Headquarters, Israel Defense Forces, Ramat Gan, Mortality in Critically Ill Traumatic Brain Injury Patients
Israel Than in Critically Ill Trauma Patients Without
2. Division of Anesthesia, Intensive Care, and Pain Manage­ Brain Injury
ment, Tel­Aviv Medical Center and Sackler Faculty of Med­ David J. Douin, MD; Layne Dylla, MD, PhD; Erin L. Ander­
icine, Tel Aviv University, Tel­Aviv, Israel son, RN, University of Colorado School of Medicine, Aurora,
3. Department of Radiology, Hadassah Hebrew University CO, USA; John D. Rice, PhD; Conner L. Jackson, MS, Col­
Medical Center, Jerusalem, Israel orado School of Public Health, Aurora, CO, USA; Robert T.
4. The Azrieli Faculty of Medicine, Bar­Ilan University, Safed, Neumann, MD, University of Colorado School of Medicine,
Israel Aurora, CO, USA; Col Vikhyat Bebarta, MD, University of
5. Israel Defense Forces, Northern Command Surgeon Colorado School of Medicine Center for COMBAT Research,
Background: Junctional hemorrhage (from the junction be­ Aurora, CO, USA; and Colorado School of Public Health, Au­
tween the limbs and torso) is a leading cause of preventable rora, CO; MAJ Steven G. Schauer, DO, MS, US Air Force 59th
death on the battlefield (19.2% of lethal hemorrhages), and Medical Wing, Office of the Chief Scientist, JBSA Lackland,
is unamenable by standard tourniquets, while junctional tour­ TX, USA, and US Army Institute of Surgical Research, JBSA
niquet application is difficult and time consuming. Pressure Fort Sam Houston, TX, USA; Adit A. Ginde, MD, MPH, Uni­
points maneuver, the practice of stopping or limiting major versity of Colorado School of Medicine, Aurora, CO, USA;
bleeding by manually compressing a major artery against a and Center for COMBAT Research, University of Colorado
bony structure to stop blood flow distal to that point, is no School of Medicine, Aurora, CO, USA; *Drs. Douin and Dylla
longer recommended by the leading pre­hospital care guide­ contributed equally to the work of this study.
lines, following a single study questioning its effectiveness. Background: Both hypoxia and hyperoxia are associated with
The current study re­addresses this issue, assessing the ef­ increased mortality among critically injured civilians and
fectiveness of supraclavicular and femoral pressure points at military personnel. However, the risks of hyperoxia in trau­
stopping blood flow to the limb in elite combat soldiers. Meth- matic brain injury (TBI) patients relative to other critically ill
ods: In this interim analysis of a prospective human volunteer trauma patients remain unknown. Methods: We performed a
study, twenty­four special operations forces medics applied the secondary analysis of a multicenter retrospective cohort study
supraclavicular and femoral pressure points following brief in­ of 3,464 critically injured adult patients presenting to three re­
struction. Distal blood flow was measured using pulse wave gional trauma centers (two level I and one level II) between
Doppler ultrasound until complete cessation of blood flow October 1, 2015, and June 30, 2018. The primary outcome
and for an additional three minutes afterward. Time to com­ was in­hospital mortality. Secondary outcomes included pro­
plete blood flow cessation and cumulative time of blood flow portion of time spent in hyperoxia (defined as SpO2 >96% or
absence within those minutes was recorded. Results: Nearly PaO2>100mmHg) and ventilator free days (VFD). Results: Af­
all participants (aged 21.7±1.1) successfully achieved complete ter adjusting for ICU length of stay and mechanical ventilation
arrest of distal blood flow using the supraclavicular (95.8%) status, critically ill TBI patients spent a significantly greater
and femoral (100%) pressure points within 10.3±23.8 and amount of time in hyperoxia than their critically ill non­TBI
3.8±2.5 seconds, respectively. Adequate pressure was main­ counterparts (49.2% vs 44.0%; p<0.001). A total of 163/1524
tained for 178.3±5.1/180 seconds in the femoral point and patients (10.7%) died in the TBI group, and 101/1940 pa­
117.1±41.6/180 seconds in the supraclavicular point. Conclu­ tients (5.2%) died in the non­TBI group. The risk for mortality
sion These results demonstrate that under laboratory condi­ was significantly higher for TBI patients with hyperoxia than
tions following minimal instruction, soldiers could effectively non­TBI patients with hyperoxia. At any fixed SpO2 level, for
stop or significantly decrease distal blood loss by applying two both patients with and without TBI, the risk of mortality in­
clinically relevant pressure points for a reasonable time period. creased with increasing FiO2. This trend was observed at all
This suggests that with appropriate training, this practice is FiO2 and SpO2 levels but was more pronounced at lower FiO2

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