Professor Michael ReadeAM, Mayne Professor of Critical Care, University of Queensland, Australia
Professor Reade is Head of the Greater Brisbane Clinical School of the University of Queensland and until 2021 with the rank of Brigadier was Director General of the Health Reserve of the Australian Army. He continues to lead an expanding research program focussed on military trauma medicine based at UQ, covering trauma systems design, blood and fluid resuscitation in trauma, and traumatic brain injury. Since 2011 he has been the Professor of Military Medicine and Surgery at the ADF’s Joint Health Command. He is an intensive care physician at the Royal Brisbane and Women’s Hospital, and an anaesthetist at Ipswich Hospital.
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Tourniquets, TXA and Prehospital Blood: What Works and What Doesn’t?
The US Joint Trauma System Guidelines for Damage Control Resuscitation (including surgery) are being revised in 2024. During the process of revision, reviews of published evidence along with reports of experience from contemporary conflict have revealed several controversies, some of which have relevance to civilian trauma management. These include:
• The utility (or lack thereof) of arterial tourniquets in the context of prolonged field care, and what might be done about this
• Tranexamic acid – how much, when, for whom, and with what long term effects?
• Should lyophilised plasma be widely available? If so, why is it not?
• What decisions need to be made when implementing a prehospital whole blood program?
• Is TEG / ROTEM delivering all it promised?
• Will REBOA ever be used at scale to good effect?
Notwithstanding incomplete evidence, clinicians cannot wait for definitive trials, as decisions need to be made for patients today. The best available evidence must be combined with judgement based on knowledge of individual patients.
• The utility (or lack thereof) of arterial tourniquets in the context of prolonged field care, and what might be done about this
• Tranexamic acid – how much, when, for whom, and with what long term effects?
• Should lyophilised plasma be widely available? If so, why is it not?
• What decisions need to be made when implementing a prehospital whole blood program?
• Is TEG / ROTEM delivering all it promised?
• Will REBOA ever be used at scale to good effect?
Notwithstanding incomplete evidence, clinicians cannot wait for definitive trials, as decisions need to be made for patients today. The best available evidence must be combined with judgement based on knowledge of individual patients.
