UC researchers receive more than $1M grant to study complex traumatic injuries of warfare

Trauma and critical care researchers at the University of Cincinnati (UC) have received more than $1 million from the United States Air Force in a recent set of grant awards to study how air medical evacuation affects patients, medical professionals and medical equipment.

The new funding supports seven research projects led by eight members of UC's Institute for Military Medicine.

The institute, a collaboration among basic science and clinical researchers, trauma surgeons and Air Force members based at University of Cincinnati Medical Center, is focused on studying the complex traumatic injuries of warfare.

In 2010, the Air Force approved a $24 million cooperative agreement to fund UC research on the unique environment of air medical evacuation. With this new funding, researchers will continue ongoing work and launch new projects.

Associate professor of surgery Timothy Pritts, MD, PhD, will direct two of the seven projects: studying the best method of resuscitation before transporting hypotensive injured patients and investigating effects of freezing red blood cells for transport into theater. The second project will provide more information about a new strategy to potentially increase the effectiveness of resuscitation with stored red blood cell units.

Other projects are co-led by UC faculty members and the USAF personnel who serve as the teaching cadre for UC's Center for Sustainment of Trauma and Readiness Skills (C-STARS).

Based at UC Medical Center, the C-STARS program trains the physicians, nurses and respiratory therapists who treat and transport wounded military members from the combat theater to military base hospitals.

In a project co-led by C-STARS cadre member Lt. Col. Elena Schlenker, a registered nurse, and clinical professor of surgery Richard Branson, MSc, researchers will study the effect of reduced barometric pressure during flight on the Critical Care Air Transport (CCAT) team members-to better understand how reduced blood oxygenation might affect the caregivers and their performance.

Three other newly funded studies will investigate how altitude affects the medical equipment used by CCATT members during evacuation flights, including ventilators, pulse oximeters, and endotracheal tubes.

"At altitude, the barometric pressure falls and the amount of available oxygen is reduced-this is commonly known as 'thin air', says Branson. "This environment also causes gases in a closed space to expand, which can cause the cuff of an endotracheal tube to expand in a patient's airway. This puts the patients at risk of reduced blood flow and tissue damage. We plan to evaluate methods to automatically control the cuff pressure during takeoff and landing, in order to maintain a safe level of pressure for the patient."

Additionally, a project led by Branson and USAF Maj. Travis Gerlach, MD, associate professor of surgery, will develop a searchable database of the more than 5,000 CCATT missions flown made during the wars in Iraq and Afghanistan.

Branson says that the searchable database will allow investigators to examine treatments and complications during air medical evacuation.

"As an example, there's interest in studying cabin altitude restriction, or limiting the barometric pressure within the aircraft," he says. "Some patient conditions, including eye injuries and head injuries, may benefit from maintaining a different barometric pressure within the aircraft, but that can add significant fuel costs and can slow transport times."