Purpose: There is increasing evidence that use of ECMO is beneficial in major trauma patients with refractory organ failure. Hence, increased numbers of ECMO support following major trauma are reported. We set out to determine the use of ECMO among major trauma patients submitted to the TraumaRegister DGUr ^® as well as patient features associated with ECMO support. Methods: The TraumaRegister DGU ^® is a multinational database compiling trauma related health care data from point-of-injury, initial and critical care to outcome. Major trauma cases (AIS ≥ 3 irrespective of injury location) with subsequent critical care as well as respiratory and/or circulatory failure (SOFA score ≥ 3 per respective category) enrolled in the TraumaRegister DGU ^® between 2015 and 2022 were reviewed. A logistic regression model was carried out to evaluate patient features associated with ECMO support. Results: 410/ 22,548 individuals (1.8%) received ECMO support. Survival among ECMO patients was 46.1%. At discharge, good functional outcome as indicated by a Glasgow outcome scale > 3 was observed for 97 ECMO patients (23.6%). Age > 65 (OR 95%-CI 1.90, 1.52–2.60), male sex (OR 1.49, 95%-CI 1.41–1.95), coagulopathy at admission to the emergency department (OR 2.37, 95%-CI 1.88-3.00), chest trauma (OR 2.12, 95%-CI 1.61–2.81), sepsis (OR 2.94, 95%-CI 1.93–2.97), as well as massive transfusion (OR 2.23, 95%-CI1.56-3.19) were associated with the use of ECMO following trauma. Conclusion: In the TraumaRegister DGU ^® , ECMO for trauma related organ failure remains rare. Among ECMO patients, good functional outcome was observed infrequently. However, the design of the registry did not allow for capturing granular data on ECMO management and timing of organ failure. Hence, outcome data should be interpreted with caution. Nevertheless, evaluation of factors associated with ECMO support after trauma might contribute to early identification of ECMO candidates and improve patient distribution for trauma centers without ECMO capability.

Zusammenfassung: Hintergrund: Durch Veränderungen in der Krankenhauslandschaft nehmen Interhospitaltransporte (IHT) einen immer höheren Stellenwert im Rettungsdienst ein. Durch die Spannbreite der Anforderungen hinsichtlich Personals und Rettungsmittel bedürfen diese Transporte einer sorgfältigen Einsatzplanung. Zielsetzung: Um den Status quo zu untersuchen, führten wir eine Analyse im Versorgungsbereich der Integrierten Regionalleitstelle Mitte (IRLS-Mitte) in Schleswig-Holstein durch. Material und Methoden: Im Zeitraum vom 01.10.2021 bis 30.09.2022 wurden arztbegleitete IHT analysiert. Ergebnisse: Von insgesamt 158.823 dokumentierten Einsätzen der ILRS-Mitte konnten 2264 (1,4 %) Datensätze als arztbegleitete IHT identifiziert und eingeschlossen werden. Es erfolgten 1389 Transporte (61,4 %) durch spezialisierte Rettungsmittel, sowie 875 (38,6 %) durch Rettungsmittel der Primärversorgung. Der Einsatz von Primärrettungsmittel erfolgte schwerpunktmäßig bei zeitkritischen Verlegungen und außerhalb der Dienstzeiten des Intensivtransportwagens (ITW)/Verlegungseinsatzfahrzeugs (VEF), 21,2 % erfolgten luftgebunden. Bei 43,1 % aller Transporte handelte es sich um Aufwärtsverlegungen. Diskussion: Arztbegleitete IHT nehmen einen relevanten Anteil am Einsatzspektrum des Rettungsdiensts ein und betreffen sowohl Rettungsmittel der Primärversorgung als auch spezialisierte Rettungsmittel. Außerhalb der Vorhaltezeiten von ITW/VEF übernehmen Notarzteinsatzfahrzeuge (NEF) und Rettungstransporthubschrauber (RTH) vorrangig die Transporte. Für die nächtlichen Notfalltransporte ist aufgrund des Zeitvorteils eine Ausweitung der luftgebundenen Verlegungskapazitäten zu erwägen. Für weniger dringliche Transporte könnte eine Anpassung der Kapazitäten spezialisierter bodengebundener Rettungsmittel in Schleswig-Holstein sinnvoll sein.

The presence of traumatic brain injury (TBI) is a critical determinant of post-traumatic mortality and morbidity. Not only is TBI one of the leading causes of death among severely injured patients, but it also substantially impacts long-term outcomes following severe trauma. Neurocritical care has a profound effect on outcomes following brain injury; nevertheless, its application in preclinical studies remains infrequent. This review therefore discusses strategies to improve the translational relevance of experimental TBI research, including the integration of neurocritical care principles in animal models. The review further addresses the impact of observation periods after injury and the selection of appropriate animal models (large vs. small animal models). In addition, commonly used injury induction methods—including controlled cortical impact (CCI), fluid percussion injury (FPI), weight-drop models, and blast injury paradigms—are discussed in terms of their reproducibility and clinical relevance. Finally, the review explores whether age, comorbidities, and sex influence TBI outcomes—and, if so, how these variables should be incorporated into experimental designs to improve translational fidelity.

Background: Acute and chronic pre-traumatic cigarette smoke exposure increases morbidity and mortality after trauma and hemorrhage. In mice with a genetic deletion of the H₂S-producing enzyme cystathione-γ-lyase (CSE^−/−), providing exogenous H₂S using sodium thiosulfate (Na₂S₂O₃) improved organ function after chest trauma and hemorrhagic shock. Therefore, we evaluated the effect of Na₂S₂O₃ during resuscitation from blunt chest trauma and hemorrhagic shock on CSE^−/− mice with pre-traumatic cigarette smoke (CS) exposure. Since H₂S is well established as being able to modify energy metabolism, a specific focus was placed on whole-body metabolic pathways and mitochondrial respiratory activity. Methods: Following CS exposure, the CSE^−/− mice underwent anesthesia, surgical instrumentation, blunt chest trauma, hemorrhagic shock for over 1 h (target mean arterial pressure (MAP) ≈ 35 ± 5 mmHg), and resuscitation for up to 8 h comprising lung-protective mechanical ventilation, the re-transfusion of shed blood, fluid resuscitation, and continuous i.v. noradrenaline (NoA) to maintain an MAP ≥ 55 mmHg. At the start of the resuscitation, the mice randomly received either i.v. Na₂S₂O₃ (0.45 mg/g_bodyweight; n = 14) or the vehicle (NaCl 0.9%; n = 11). In addition to the hemodynamics, lung mechanics, gas exchange, acid–base status, and organ function, we quantified the parameters of carbohydrate, lipid, and protein metabolism using a primed continuous infusion of stable, non-radioactive, isotope-labeled substrates (gas chromatography/mass spectrometry) and the post-mortem tissue mitochondrial respiratory activity (“high-resolution respirometry”). Results: While the hemodynamics and NoA infusion rates did not differ, Na₂S₂O₃ was associated with a trend towards lower static lung compliance (p = 0.071) and arterial PO₂ (p = 0.089) at the end of the experiment. The direct, aerobic glucose oxidation rate was higher (p = 0.041) in the Na₂S₂O₃-treated mice, which resulted in lower glycemia levels (p = 0.050) and a higher whole-body CO₂ production rate (p = 0.065). The mitochondrial respiration in the heart, kidney, and liver tissue did not differ. While the kidney function was comparable, the Na₂S₂O₃-treated mice showed a trend towards a shorter survival time (p = 0.068). Conclusions: During resuscitation from blunt chest trauma and hemorrhagic shock in CSE^−/− mice with pre-traumatic CS exposure, Na₂S₂O₃ was associated with increased direct, aerobic glucose oxidation, suggesting a switch in energy metabolism towards preferential carbohydrate utilization. Nevertheless, treatment with Na₂S₂O₃ coincided with a trend towards worsened lung mechanics and gas exchange, and, ultimately, shorter survival.