{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:44:05Z","timestamp":1783676645807,"version":"3.55.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"5-6","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>We describe a 34-year-old soldier who sustained a blast injury in Syria resulting in tracheal 5\u2009cm tracheal loss, cervical spine and cord injury with tetraplegia, multiple bilateral rib fractures, esophageal injury, traumatic brain injury, globe evisceration, and multiple extremity soft tissue and musculoskeletal injuries including a left tibia fracture with compartment syndrome. An emergent intubation of the transected trachea was performed in the field, and the patient was resuscitated with whole blood prehospital. During transport to the Role 2, the patient required cardiopulmonary resuscitation for cardiac arrest. On arrival, he underwent a resuscitative thoracotomy and received a massive transfusion exclusively with whole blood. A specialized critical care team transported the patient to the Role 3 hospital in Baghdad, and the DoD extracorporeal membrane oxygenation (ECMO) team was activated secondary to his unstable airway and severe hypoxia secondary to pulmonary blast injury. The casualty was cannulated in Baghdad approximately 40\u2009hours after injury with bifemoral cannulae in a venovenous configuration. He was transported from Iraq to the U.S. Army Institute of Surgical Research Burn Center in San Antonio without issue. Extracorporeal membrane oxygenation support was successfully weaned, and he was decannulated on ECMO day 4. The early and en route use of venovenous ECMO allowed for maintenance of respiratory support during transport and bridge to operative management and demonstrates the feasibility of prolonged ECMO transport in critically ill combat casualties.<\/jats:p>","DOI":"10.1093\/milmed\/usab354","type":"journal-article","created":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T05:50:56Z","timestamp":1630129856000},"page":"e1344-e1349","source":"Crossref","is-referenced-by-count":7,"title":["A Case Report of Combat Blast Injury Requiring Combat Casualty Care, Far-Forward ECMO, Air Transport, and All Levels of Military Critical Care"],"prefix":"10.1093","volume":"188","author":[{"given":"Lydia C","family":"Piper","sequence":"first","affiliation":[{"name":"Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason J","family":"Nam","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital , Durham, NC 27710, USA"},{"name":"Department of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P","family":"Kuckelman","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Brigham and Women\u2019s Hospital , Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie G","family":"Sams","sequence":"additional","affiliation":[{"name":"Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffry D","family":"DellaVolpe","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Brigham and Women\u2019s Hospital , Boston, MA 02115, USA"},{"name":"Methodist Healthcare System , San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauer","family":"Biscotti","sequence":"additional","affiliation":[{"name":"Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A","family":"Negaard","sequence":"additional","affiliation":[{"name":"Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip E","family":"Mason","sequence":"additional","affiliation":[{"name":"Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M","family":"Gurney","sequence":"additional","affiliation":[{"name":"Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,28]]},"reference":[{"issue":"20","key":"2023051613352689800_R1","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1056\/NEJMct1103720","article-title":"Extracorporeal membrane oxygenation for ARDS in adults","volume":"365","author":"Brodie","year":"2011","journal-title":"N Engl J Med"},{"issue":"4","key":"2023051613352689800_R2","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1164\/rccm.201710-2130CP","article-title":"The Extracorporeal Life Support Organization Maastricht Treaty for Nomenclature In Extracorporeal Life Support. A position paper of the extracorporeal life support organization","volume":"198","author":"Conrad","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"issue":"7","key":"2023051613352689800_R3","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.resuscitation.2010.02.020","article-title":"Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock","volume":"81","author":"Arlt","year":"2010","journal-title":"Resuscitation"},{"issue":"1","key":"2023051613352689800_R4","doi-asserted-by":"crossref","DOI":"10.1186\/cc13702","article-title":"Mechanical ventilation during extracorporeal membrane oxygenation","volume":"18","author":"Schmidt","year":"2014","journal-title":"Crit Care"},{"issue":"4","key":"2023051613352689800_R5","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1378\/chest.107.4.1083","article-title":"Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units. An international, multicenter, prospective survey","volume":"107","author":"Vasilyev","year":"1995","journal-title":"Chest"},{"issue":"4","key":"2023051613352689800_R6","first-page":"551","article-title":"Acute respiratory insufficiency. Treatment with prolonged extracorporeal oxygenation","volume":"64","author":"Hill","year":"1972","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"17","key":"2023051613352689800_R7","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1001\/jama.2009.1535","article-title":"Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome","volume":"302","author":"Davies","year":"2009","journal-title":"JAMA"},{"issue":"9698","key":"2023051613352689800_R8","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/S0140-6736(09)61069-2","article-title":"Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial","volume":"374","author":"Peek","year":"2009","journal-title":"Lancet"},{"issue":"11\u201312","key":"2023051613352689800_R9","doi-asserted-by":"crossref","first-page":"e2055","DOI":"10.1093\/milmed\/usaa215","article-title":"Evolution of the United States military extracorporeal membrane oxygenation transport team","volume":"185","author":"Read","year":"2020","journal-title":"Mil Med"},{"key":"2023051613352689800_R10","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.ijsu.2020.10.034","article-title":"The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) guidelines","volume":"84","author":"Agha","year":"2020","journal-title":"Int J Surg"},{"issue":"5","key":"2023051613352689800_R11","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1001\/jama.2015.12","article-title":"Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial","volume":"313","author":"Holcomb","year":"2015","journal-title":"Jama"},{"issue":"9\u201310","key":"2023051613352689800_R12","doi-asserted-by":"crossref","first-page":"e644","DOI":"10.1093\/milmed\/usx132","article-title":"The feasibility of venovenous ECMO at Role-2 facilities in austere military environments","volume":"183","author":"Mohamed","year":"2018","journal-title":"Mil Med"},{"issue":"suppl_2","key":"2023051613352689800_R13","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1093\/milmed\/usy120","article-title":"Whole blood transfusion","volume":"183","author":"Cap","year":"2018","journal-title":"Mil Med"},{"issue":"Suppl 3","key":"2023051613352689800_R14","first-page":"S180","article-title":"Improved survival in critically injured combat casualties treated with fresh whole blood by forward surgical teams in Afghanistan","volume":"60","author":"Gurney","year":"2020","journal-title":"Transfusion"},{"issue":"Suppl 1","key":"2023051613352689800_R15","doi-asserted-by":"crossref","first-page":"107s","DOI":"10.1111\/trf.12044","article-title":"Fresh whole blood use by forward surgical teams in Afghanistan is associated with improved survival compared to component therapy without platelets","volume":"53","author":"Nessen","year":"2013","journal-title":"Transfusion"},{"issue":"4 Suppl","key":"2023051613352689800_R16","first-page":"S69","article-title":"Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries","volume":"66","author":"Spinella","year":"2009","journal-title":"J Trauma"},{"issue":"3","key":"2023051613352689800_R17","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1111\/trf.15086","article-title":"The use of whole blood in US military operations in Iraq, Syria, and Afghanistan since the introduction of low-titer Type O whole blood: feasibility, acceptability, challenges","volume":"59","author":"Vanderspurt","year":"2019","journal-title":"Transfusion"},{"issue":"8","key":"2023051613352689800_R18","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1007\/s00268-018-4480-6","article-title":"Veno-venous extracorporeal membrane oxygenation (VV ECMO) for acute respiratory failure following injury: outcomes in a high-volume adult trauma center with a dedicated unit for VV ECMO","volume":"42","author":"Menaker","year":"2018","journal-title":"World J Surg"},{"issue":"3","key":"2023051613352689800_R19","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1378\/chest.12-3081","article-title":"Midodrine: a novel therapeutic for refractory chylothorax","volume":"144","author":"Liou","year":"2013","journal-title":"Chest"},{"issue":"1","key":"2023051613352689800_R20","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/TA.0b013e318250bfb4","article-title":"Combat wounds in Iraq and Afghanistan from 2005 to 2009","volume":"73","author":"Belmont","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"1SSuppl 1","key":"2023051613352689800_R21","doi-asserted-by":"crossref","first-page":"S165","DOI":"10.1097\/TA.0000000000002217","article-title":"Prehospital trauma experience of the Israel defense forces on the Syrian border 2013-2017","volume":"87","author":"Benov","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"issue":"1562","key":"2023051613352689800_R22","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1098\/rstb.2010.0252","article-title":"Blast injuries to the lung: epidemiology and management","volume":"366","author":"Mackenzie","year":"2011","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"issue":"2","key":"2023051613352689800_R23","first-page":"295","article-title":"Combat wounds in operation Iraqi Freedom and Operation Enduring Freedom","volume":"64","author":"Owens","year":"2008","journal-title":"J Trauma"},{"issue":"suppl_1","key":"2023051613352689800_R24","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1093\/milmed\/usx160","article-title":"Case report of extracorporeal membrane oxygenation and aeromedical evacuation at a deployed military hospital","volume":"183","author":"Hamm","year":"2018","journal-title":"Mil Med"},{"issue":"2","key":"2023051613352689800_R25","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/TA.0000000000001076","article-title":"A critical literature review on primary blast thorax injury and their outcomes","volume":"81","author":"Boutillier","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"issue":"21","key":"2023051613352689800_R26","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1056\/NEJMoa1800385","article-title":"Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome","volume":"378","author":"Combes","year":"2018","journal-title":"N Engl J Med"},{"issue":"3","key":"2023051613352689800_R27","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s12245-010-0192-x","article-title":"Successful treatment of a severely injured soldier from Afghanistan with pumpless extracorporeal lung assist and neurally adjusted ventilatory support","volume":"3","author":"Bein","year":"2010","journal-title":"Int J Emerg Med"},{"issue":"6","key":"2023051613352689800_R28","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1097\/TA.0b013e3182782480","article-title":"Transportable extracorporeal lung support for rescue of severe respiratory failure in combat casualties","volume":"73","author":"Bein","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"4 Suppl","key":"2023051613352689800_R29","first-page":"S164","article-title":"Air transport of patients with severe lung injury: development and utilization of the Acute Lung Rescue Team","volume":"66","author":"Dorlac","year":"2009","journal-title":"J Trauma"},{"issue":"1 Suppl","key":"2023051613352689800_R30","first-page":"S91","article-title":"Closing the \u201ccare in the air\u201d capability gap for severe lung injury: the Landstuhl Acute Lung Rescue Team and extracorporeal lung support","volume":"71","author":"Fang","year":"2011","journal-title":"J Trauma"},{"issue":"3","key":"2023051613352689800_R31","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1097\/MAT.0b013e3180574b37","article-title":"From Baghdad to Germany: use of a new pumpless extracorporeal lung assist system in two severely injured US soldiers","volume":"53","author":"Zimmermann","year":"2007","journal-title":"Asaio J"},{"issue":"11-12","key":"2023051613352689800_R32","doi-asserted-by":"crossref","first-page":"e471","DOI":"10.1093\/milmed\/usy014","article-title":"Critical care in the Military Health System: a survey-based summary of critical care services","volume":"183","author":"Nam","year":"2018","journal-title":"Mil Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/5-6\/e1344\/50342239\/usab354.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/5-6\/e1344\/50342239\/usab354.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T23:17:36Z","timestamp":1699399056000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/5-6\/e1344\/6358819"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,28]]},"references-count":32,"journal-issue":{"issue":"5-6","published-online":{"date-parts":[[2021,8,28]]},"published-print":{"date-parts":[[2023,5,16]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usab354","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,5,1]]},"published":{"date-parts":[[2021,8,28]]}}}