Injuries are a major reason for visits to an emergency department. These can result in immediate threat to life, long-term disability, reduced function, and reduced participation. Understanding better ways to stabilize, treat, and support persons who have an acute injury is a cornerstone of emergency medicine.
The University of Pittsburgh Departments of Emergency Medicine and Surgery lead the Linking Investigations in Trauma and Emergency Services trauma research network, funded by the Department of Defense. Collaborative prehospital research studies have included the development of large prehospital and in-hospital trauma data repositories, whole blood resuscitation, and an advanced airway trial.
Ongoing Studies
- Autonomous Diagnosis and Management of the Critically Ill during Air Transport (ADMIT)
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First, we will develop multivariable models through ML data-driven classification techniques to predict cardiorespiratory instability. Second, we will evaluate our existing clinical decision support (CDS) tools to interface with FHM principles and ML- defined interactions, and trial this in silico first on our porcine hemorrhagic shock resuscitation, then on STAT MedEvac data, followed by prospective human simulation on flight crew paramedics and nurses during annual training for agreement and benefit, defining effectiveness based on diagnosis accuracy, time to diagnosis, intervention choice accuracy and time to intervention. Finally, we will evaluate the resultant semi-autonomous management protocol initially in retrospect in 100 STAT MedEvac patients and 10 Emergency Department trauma patients and then prospectively by active CDS in a final 100 STAT MedEvac patients. We will prospectively analyze the effectiveness of these calibrated CDS tools for predictive ability of the various ML models and apply the best, most practical and parsimonious predictive models for clinical care during transport based on patient population, pathological processes and support staff.
- Prehospital Airway Control Trial (PACT)
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The Prehospital Airway Control Trial (PACT) is a 5 year, open label, multi-center, stepped-wedge randomized trial comparing airway management strategies of prehospital trauma patients. The initial airway attempt will be randomized to either usual care (control) or a supraglottic airway management approach (intervention). The primary outcome will be 24 hour survival, with secondary outcomes to include survival to hospital discharge, expected clinical adverse events, airway management performance, ICU length of stay, ventilator days, incidence of ARDS, and incidence of ventilator associated pneumonia. Subjects will be enrolled across approximately 17 prehospital agencies at select LITES Network sites and will enroll a total of 2,009 subjects.
- Type O Whole Blood and Assessment of Age During Prehospital Resuscitation Trial (TOWAR)
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Open label, multi-center, pre-hospital randomized trial utilizing 10 Level 1 trauma centers designed to determine the efficacy and safety of low titer whole blood resuscitation as compared to standard of care resuscitation in patients at risk of hemorrhagic shock and to appropriately characterize the hemostatic competency of whole blood relative to its age.
Select Completed Studies
Prehospital Blood Product and Crystalloid Resuscitation in the Severely Injured Patient: A Secondary Analysis of the Prehospital Air Medical Plasma Trial
Francis Guyette, Jason Sperry, Andrew Peitzman, Timothy Billiar, Brian Daley, Richard Miller, Brian Harbrecht, Jeffrey Claridge, Tyler Putnam, Therese M Duane, Herb Phelan, Joshua Brown | Annals of Surgery (2021)
Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock
Jason Sperry, Francis Guyette, Joshua Brown, Mark Yazer, Darrell Triulzi, Barbara Early-Young, Peter Adams, Brian Daley, Richard Miller, Brian Harbrecht, Jeffrey Claridge, Herb Phelan, William Witham, A Tyler Putnam, Therese Duane, Louis Alarcon, Clifton Callaway, Brian Zuckerbraun, Matthew Neal, Matthew Rosengart, Raquel Forsythe, Timothy Billiar, Donald Yealy, Andrew Peitzman, Mazen Zenati | New England Journal of Medicine (2018)