Nehlushchenko S. Traumatic blood loss. Optimization of therapeutic and diagnostic measures at the prehospital and early hospital stages

Severe mechanical trauma remains one of the leading medical and social problems of our time, claiming more than 5.8 million lives annually. According to expert forecasts, this figure may increase to eight million in the coming years. Among potentially preventable causes of death, massive blood loss and the resulting circulatory and metabolic disturbances play a leading role. According to various data, they account for 53.7–80% of fatal outcomes in trauma cases. At the same time, up to half of deaths due to traumatic blood loss occur at the pre-hospital stage, before the victim receives emergency medical care. Despite significant advances in global medical science, the severe course of traumatic disease and mortality rates remain high and largely depend on the organization of medical care at all stages of its delivery. Unfortunately, available scientific literature reviews reveal substantial discrepancies in terminology, indications for initiating infusion therapy, the choice of medications, and the use of blood transfusions at the pre-hospital stage. Modern European protocols and guidelines for emergency medical care require adaptation. The dissertation presents a theoretical substantiation and a practical solution to a scientific problem involving the clinical-epidemiological and clinical-nosological analysis of patients with massive blood loss, as well as the justification of a risk-oriented approach to providing medical care to patients at the pre-hospital stage. A total of 287 patients with massive traumatic blood loss who were treated by staff of the Sumy Regional Center for Emergency Medical Care and Disaster Medicine between January 1, 2020, and December 31, 2023, were studied and analyzed. The research methods included bibliosemantic, clinical, instrumental, experimental, systemic, and comparative analyses, clinical risk management for predicting the course of the traumatic process, and statistical analysis. As a result of the study, an important scientific objective was achieved: the clinical-epidemiological and clinical-nosological characteristics of patients were analyzed, clinical outcome risks of disability were identified, and risk-generating factors were determined. The informativeness of visual assessment of external blood loss volume was studied. Visual estimation of blood loss is too inaccurate to have practical clinical application. Practical experience did not improve the accuracy of such assessments in this limited study. However, visual assessment may be more useful when combined with hemodynamic parameters of the patient. The informativeness of the gravimetric method for determining intraoperative blood loss volume using the developed computer program “Gravimetric Method for Blood Loss Assessment” was analyzed. This method is cost-effective and easy to perform. It provides an automatic calculation of blood loss in near real time and can be used as a supplement to visual assessment, as well as in conjunction with hemodynamic indicators. A new risk-oriented protocol scheme for emergency medical care for patients with massive uncontrolled blood loss at the pre-hospital and early hospital stages was developed. It integrates the Shock Index (SI), the AVPU scale for assessing consciousness, the American College of Surgeons classification of blood loss, the MARCH algorithm for determining priority interventions, and the ABC score for predicting the need for blood transfusion. The developed risk-oriented protocol scheme made it possible to significantly reduce the time required for clinical and organizational decision-making by an average of 6.25 minutes (p = 0.032). At the same time, there is a tendency toward a reduction in the duration of the комплекс of diagnostic and therapeutic measures at the prehospital and early hospital stages of treatment by an average of 8.89 minutes (p = 0.149), although this does not reach the level of statistical significance.