VCU news

By Frances Dumenci

Continuing its mission to improve survival and the quality of life of critical illness and injury victims, the Virginia Commonwealth University Reanimation Engineering Science Center (VCURES) was recently awarded a $5.57 million grant from the U.S. Army Medical Research and Material Command, Combat Casualty Care Research Program.

The grant will fund a study examining plasma versus saline as the most appropriate resuscitation fluid given to victims of critical injury by first contact emergency medical services personnel.

In the resuscitation of severe trauma, a coagulopathic state, or an inability to clot normally, develops within the first minutes to hours after trauma. Fluid resuscitation with traditional fluids such as saline solution appears to worsen the coagulation issue and leads to further bleeding and complications.

Plasma is part of the blood that contains all the valuable proteins that help promote clotting after injury. While plasma is commonly given to victims of severe injury in the first moments after reaching a trauma center, this study will attempt to shorten the time of plasma administration to victims from the time of injury. By giving plasma sooner, it may be possible to control bleeding earlier and improve survival.

The study will lay the groundwork for civilian and military improvements in treatment of the most severely injured victims with poorly controlled limb, chest and intra-abdominal hemorrhage, or bleeding, using plasma.

“We have begun preliminary work on this three-year study, getting the team of researchers together and planning logistics,” said Bruce Spiess, M.D., professor in the VCU Department of Anesthesiology and principal investigator on the study. “This will be a multidisciplinary team including clinical researchers, pharmacists, engineers, mathematicians and others. Few institutions in the country have the expertise across the spectrum found at VCU.

“We’re also involving the community in this research and will be collaborating with blood bank staff as well as fire and rescue paramedics in the Richmond region,” Spiess said.

One of the goals of the study is to provide proposed logistical solutions of how to put plasma forward into the field when treating critically wounded soldiers in combat. Rapid, effective resuscitation is of great consequence to the wounded combatant.

If improved outcomes for victims are demonstrated, then results from the study may help reduce the transfusion demand and decrease infection, multisystem organ failure, length of hospital stay and mortality both for military personnel as well as civilian trauma victims.

VCURES has received several grants from different divisions within the Department of Defense, including the Office of Naval Research and the Army, to advance technology and treatments used in combat medical care. These advancements are also translated and used in civilian practice.

“The Department of Defense knows we can deliver. It has looked at the body of work by VCURES researchers over the last decade,” said Spiess, a cardiothoracic anesthesiologist recognized as a world authority on oxygen therapeutics, transfusion and coagulation medicine. “We are the tip of the spear in the effort to develop the next generation of resuscitation fluid and delivery to the critically ill and injured.”

The VCURES team is collaborating with other researchers and centers on campus, including the VCU Center for Clinical and Translational Research (CCTR), using its services and tools in the research incubator and community engagement core.

“All the research we do at VCURES is translational, accelerating discoveries from the laboratory and winding up with a product or treatment that will improve patient care,” said Kevin Ward, M.D., professor and associate chair in the Department of Emergency Medicine and director of VCURES. “The knowledge we gain and the products we create give every patient the best chance of survival from the first moment of injury or illness and throughout their care. This is team science at its greatest.”

The team includes Susan Roseff, M.D., professor of pathology, director of transfusion medicine and co-principal investigator; Rao Ivatury, M.D., professor of Surgery, chair of the Division of Trauma Surgery and co-principal investigator; Michael Kurz, M.D., assistant professor of Emergency Medicine, medical director of Henrico County EMS and co-investigator; Joseph Ornato, M.D., professor and chair of Emergency Medicine, director of Richmond Ambulance Authority and co-investigator; Therese Duane, M.D., associate professor of Surgery and co-investigator; Donald Brophy, PharmD., professor and chair of Pharmacotherapy and Outcome Science and co-investigator; Kimberly Sanford, M.D., assistant professor of Pathology and co-investigator; and, from the Center for Clinical and Translational Research, Jacob Wegelin, Ph.D., assistant professor of Biostatistics and co-investigator.

For more information about VCURES, visit www.vcures.org.