• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Military Experience with Trauma Induced ARDS on the Battlefield

Military Experience with Trauma Induced ARDS on the Battlefield

Sarah Thomas, MD1, Ryan Rhie, MPH1, Lydia Piper, MD1, James Aden, PhD1, Phillip Mason, MD1, Jennifer Gurney, MD2, James Lantry, MD3, Terry Lonergan, MD3, Brendan Beely, RRT4, Daniel Wendorff4, Andriy Batchinsky, MD4, Valerie Sams, MD1. 1SAMMC, 2ISR, 3Baltimore CSTARS, 4Geneva Foundation

OBJECTIVES: Combat injury patterns in Operations Iraqi and Enduring Freedom have changed as a result of wounding mechanisms and protective gear resulting in patients surviving highly lethal injuries.  Advances in critical care in the deployed environment and during transport has been a crucial component in the management of severely injured casualties.  ARDS presents a unique challenge in that many normal lung rescue modalities, such as nitric oxide, prone positioning, advanced ventilator techniques, and Extracorporeal Membrane Oxygenation (ECMO) are not readily employable in the deployed environment. This study seeks to determine any mortality risk factors or predictive patterns with ARDS in the combat wounded.

METHODS: We conducted a retrospective review of all US military personnel traumatically injured in theaters of operation from 2001-2015 identified as having a diagnosis of ARDS by ICD9 code. Using the Department of Defense Trauma Registry (DoDTR), we assessed demographics, prehospital and arrival vital signs and Glascow Coma Score (GCS), laboratory analysis, and mortality. Survivor and nonsurvivor groups were identified. Univariate analyses were performed with significance set at p≤0.05. Significant factors were then included in a multivariate logistic regression for mortality.

RESULTS: A total of 182 service members developed ARDS after trauma of which 42 were nonsurvivors (25% mortality).  Explosive injuries (67%) and gunshot wounds (15%) predominated. Higher mortality rates were seen among patients with higher Injury Severity Scores (ISS) (35 ± 18 vs 27 ± 13, p=0.012), lower platelet count (129 ± 103 vs 201 ± 202, p=0.008), higher INR (1.9 ± 1.0 vs 1.5 ± 0.5, p=0.033), lower base deficit (-9 ± 8 vs -3 ± 7, p=0.001) and lower pH (7.2 ± 0.1 vs 7.3 ± 0.1, p=0.013) upon arrival. Additionally, higher PaCO2 (48 ± 6 vs 45 ± 5, p=0.014) at arrival was associated with increased mortality. There was no difference between survivors and nonsurvivors vital signs upon arrival to ED, pre-arrival vitals, or GCS. Multivariate logistic regression showed ISS, PaCO2, and base deficit remained significant with an AUC of 0.84

CONCLUSIONS: Given the high mortality associated with ARDS in combat casualties, innovative rescue strategies should be considered to employ in the downrange environment and along the continuum of care.  ECMO has been utilized for years for ARDS and has been increasing in the adult trauma population.  As innovations in device technology and advances in techniques evolve, ECMO can be further incorporated into the downrange care paradigm. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95579

Program Number: MSS10

Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations

Presentation Type: MSSPodium

141

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals