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Prehospital care for multiple trauma patients in Germany

Chinese Journal of Traumatology 2015年第3期18卷 125-134页

作者： Marc Maegele Departrnent for Traumatology and Orthopedic Surgery Cologne-Merheim Medical Center (CMMC) University of Witten/Herdecke (UW/H) Ostmerheimerstr. 200 D-51109 Koln Germany

For the German speaking countries, Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first"). If no immediate treatment is necessary, a "Secondary Sur- vey" follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay ("work and go") to TR-DGU certified trauma centers of the local trauma networks. Due to the difficult prehospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung", the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

关键词：院前急救患者护理德国快速评估身体部位身体检查网络认证

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Updated concepts on the pathophysiology and the clinical management of trauma hemorrhage and coagulopathy

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Chinese Journal of Traumatology 2017年第3期20卷 125-132页

作者： Marc Maegele Zheng-Tao Gu Qiao-Bing Huang Hong Yang Department for Trauma and Orthopedic Surgery Cologne-Merheim Medical Center (CMMC) University Witten/Herdecke (UW/H) Campus Cologne-Merheim Ostmerheimerstr 200 D-51109 Koln Germany Institute for Research in Operative Medicine (IFOM) University Witten/Herdecke (UW/H) Campus Cologne-Merheim Ostmerheimerstr 200 D-51109 Koln Germany Department of Intensive Care The Third Affiliated Hospital of Southern Medical University Cuangzhou 510630 PR China Department of Pathophysiology Guangdong Provincial Key Laboratory of Shock and Microcirculation Research Southern Medical University Guangzhou 510515 PR China

Uncontrolled hemorrhage and subsequent trauma-induced coagulopathy (TIC) are still the principle causes for preventable death after trauma and early detection and aggressive management have been associated with reduced mortality. Despite increasing knowledge about trauma resuscitation, best practice to treat this newly defined entity is still under debate. A synopsis of best current knowledge with reference to the updated European trauma guideline on the management of severe trauma hemorrhage and TIC is presented. The implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome is advocated.

关键词： Hemorrhage Blood coagulation disorders Hemostatics Blood transfusion

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Acute traumatic coagulopathy：Incidence, risk stratification and therapeutic options

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World Journal of Emergency Medicine 2010年第1期1卷 12-21页

作者： Marc Maegele Department of Trauma and Orthopedic Surgery and Institute for Research in Operative Medicine (IFOM) University of Witten/Herdecke Cologne-Merheim Medical Center (CMMC) Ostmerheimerstr. 200 D-51109 Cologne Germany

BACKGROUND:Uncontrolled hemorrhage is responsible for over 50% of all trauma-related deaths within the first 48 hours after admission. Clinical observations together with recent research resulted in an appreciation of the central role of coagulopathy in acute trauma care. A synopsis is presented of different retrospective analyses based upon datasets from severe multiply injured patients derived from the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft fur Unfallchirurgie (DGU)/ German Society of Trauma Surgery) with respect to frequency, risk stratification and therapeutic options of acute traumatic coagulopathy (ATC).;METHODS:The synopsis of different analyses based upon the datasets from severe multiply injured patients derived from the TR-DGU database and development/validation of a scoring system (TASH-score = Trauma Associated Severe Hemorrhage) that allows an early and reliable estimation for the probability of massive transfusion as a surrogate for life-threatening hemorrhage after severe multiple injuries.;RESULTS:The high frequency of ATC upon emergency room admission is associated with significant morbidity and mortality in multiply injured patients. The TASH-score is recognized as an easy-to-calculate and valid scoring system to predict the individual's probability for massive transfusion and thus ongoing life-threatening hemorrhage at a very early stage after severe multiple injuries.;CONCLUSIONS:An early aggressive management of ATC including a more balanced administration of blood products to improve outcome is advocated.

关键词： Coagulopathy Epidemiology Management Risk stratification Trauma

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《SHOCK》2020年第10期新观点

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实用休克杂志（中英文） 2020年第5期4卷 308-309页

作者： Marc Maegele Qiaobing Huang 唐轶珣(译) 湖南省人民医院/湖南师范大学附属第一医院麻醉医学中心湖南省围术期加速康复麻醉临床医学研究中心急危重症代谢组学湖南省重点实验室不详

该期《休克》杂志汇编了关于改善不同类型休克预后的创新性研究。第一组的六篇文章聚焦于心源性休克。Ocak等人评估了蛋白酶激活受体-2(PAR-2)在窒息性心脏骤停模型神经炎症的潜在治疗作用[1]。这一结果证实了PAR-2介导的神经炎症与海... 详细信息

该期《休克》杂志汇编了关于改善不同类型休克预后的创新性研究。第一组的六篇文章聚焦于心源性休克。Ocak等人评估了蛋白酶激活受体-2(PAR-2)在窒息性心脏骤停模型神经炎症的潜在治疗作用[1]。这一结果证实了PAR-2介导的神经炎症与海马神经元变性损伤和神经认知功能下降有关,而抑制PAR-2可减轻神经炎症、减少海马神经元变性进而改善神经功能。该神经保护作用可能部分通过ERK1/2信号通路介导。有待进一步研究这是否涉及主要机制(如血脑屏障的保护或抗神经元凋亡)。

关键词：心源性休克神经炎症 ERK1/2信号通路窒息性神经认知功能海马神经元血脑屏障神经保护作用

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Polydatin prevents the induction of secondary brain injury after traumatic brain injury by protecting neuronal mitochondria

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Neural Regeneration Research 2019年第9期14卷 1573-1582页

作者： Li Li Hong-Ping Tan Cheng-Yong Liu Lin-Tao Yu Da-Nian Wei Zi-Chen Zhang Kui Lu Ke-Sen Zhao Marc Maegele Dao-Zhang Cai Zheng-Tao Gu Department of Treatment Center for Traumatic Injuries the Third Affiliated Hospital of Southern Medical UniversityAcademy of Orthopedics·Guangdong ProvinceGuangzhouGuangdong ProvinceChina Department of Pathophysiology Southern Medical UniversityGuangdong Provincial Key Laboratory of Shock and Microcirculation ResearchGuangzhouGuangdong ProvinceChina Department of Epilepsy Surgery Guangdong Sanjiu Brain HospitalGuangzhouGuangdong ProvinceChina Department of Emergency the Third Affiliated Hospital of Southern Medical UniversityAcademy of Orthopedics·Guangdong ProvinceGuangzhouGuangdong ProvinceChina Department of Traumatology and Orthopedic Surgery Cologne-Merheim Medical Center(CMMC)University Witten/Herdecke(UW/H)Campus Cologne-MerheimCologneGermany Department of Orthopedics the Third Affiliated Hospital of Southern Medical UniversityAcademy of Orthopedics·Guangdong ProvinceGuangzhouGuangdong ProvinceChina

Polydatin is thought to protect mitochondria in different cell types in various diseases.Mitochondrial dysfunction is a major contributing factor in secondary brain injury resulting from traumatic brain injury.To investigate the protective effect of polydatin after traumatic brain injury,a rat brain injury model of lateral fluid percussion was established to mimic traumatic brain injury insults.Rat models were intraperitoneally injected with polydatin(30 mg/kg)or the SIRT1 activator SRT1720(20 mg/kg,as a positive control to polydatin).At 6 hours post-traumatic brain injury insults,western blot assay was used to detect the expression of SIRT1,endoplasmic reticulum stress related proteins and p38 phosphorylation in cerebral cortex on the injured side.Flow cytometry was used to analyze neuronal mitochondrial superoxide,mitochondrial membrane potential and mitochondrial permeability transition pore opened.Ultrastructural damage in neuronal mitochondria was measured by transmission electron microscopy.Our results showed that after treatment with polydatin,release of reactive oxygen species in neuronal mitochondria was markedly reduced;swelling of mitochondria was alleviated;mitochondrial membrane potential was maintained;mitochondrial permeability transition pore opened.Also endoplasmic reticulum stress related proteins were inhibited,including the activation of p-PERK,spliced XBP-1 and cleaved ATF6.SIRT1 expression and activity were increased;p38 phosphorylation and cleaved caspase-9/3 activation were inhibited.Neurological scores of treated rats were increased and the mortality was reduced compared with the rats only subjected to traumatic brain injury.These results indicated that polydatin protectrd rats from the consequences of traumatic brain injury and exerted a protective effect on neuronal mitochondria.The mechanisms may be linked to increased SIRT1 expression and activity,which inhibits the p38 phosphorylation-mediated mitochondrial apoptotic pathway.This study was approved by the Animal Care and Use Committe

关键词： nerve regeneration traumatic brain injury polydatin mitochondria endoplasmic reticulum stress SIRT1 reactive oxygen species p38 mitochondrial membrane potential mitochondrial permeability transition pore lateral fluid percussion neural regeneration

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Frequency,Risk Stratification and Therapeutic Management of Acute Post-Traumatic Coagulopathy

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微循环学杂志 2009年第4期 74-74页

作者： Marc Maegele Depart ment of Trauma and Orthopedic Surgery University of Witten/HerdeckeCologne-Merhei mMedical Center (CMMC) Institute forResearchin Operative Medicine(IFOM) University of Witten/HerdeckeCologne-Merhei mMedical Center (CMMC)

Uncontrolled haemorrhage is still responsible for more than 50% of all trauma-related deaths within the first 48 hours after hospital admission. Clinical observations together with recent research resulted in a new ap... 详细信息

关键词： Frequency,Risk Stratification and Therapeutic Management of Acute Post-Traumatic Coagulopathy

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Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

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Military Medical Research 2023年第3期10卷 281-298页

作者： Fei Pei Ren‑Qi Yao Chao Ren Soheyl Bahrami Timothy RBilliar Irshad HChaudry De‑Chang Chen Xu‑Lin Chen Na Cui Xiang‑Ming Fang Yan Kang Wei‑Qin Li Wen‑Xiong Li Hua‑Ping Liang Hong‑Yuan Lin Ke‑Xuan Liu Ben Lu Zhong‑Qiu Lu Marc Maegele Tian‑Qing Peng You Shang Lei Su Bing‑Wei Sun Chang‑Song Wang Jian Wang Jiang‑Huai Wang Ping Wang Jian‑Feng Xie Li‑Xin Xie Li‑Na Zhang Basilia Zingarelli Xiang‑Dong Guan Jian‑Feng Wu Yong‑Ming Yao Department of Critical Care Medicine the First Affiliated Hospital of Sun Yat-Sen University58 Zhongshan Er RoadYuexiu DistrictGuangzhou 510080GuangdongChina Translational Medicine Research Center Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital28 Fuxing RoadHaidian DistrictBeijing 100853China Department of Burn Surgery the First Affiliated Hospital of Naval Medical UniversityShanghai 200433China Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology 1200 ViennaAustria Department of Surgery University of Pittsburgh Medical CenterPittsburghPA 15213USA Center for Surgical Research and Department of Surgery University of Alabama at BirminghamBirminghamAL 35294USA Department of Critical Care Medicine Ruijin HospitalShanghai Jiaotong UniversityShanghai 200025China Department of Burns the First Affiliated Hospital of Anhui Medical UniversityHefei 230022China Department of Critical Care Medicine Peking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Department of Anesthesiology the First Affiliated HospitalZhejiang University School of MedicineHangzhou 31003China Department of Critical Care Medicine West China Hospital of Sichuan UniversityChengdu 610041China Department of Critical Care Medicine General Hospital of Eastern Theater Command of Chinese PLANanjing 210002China Department of Surgical Intensive Critical Unit Beijing Chao‑Yang HospitalCapital Medical UniversityBeijing 100020China State Key Laboratory of Trauma Burns and Combined InjuryResearch Institute of SurgeryDaping HospitalArmy Medical UniversityChongqing 400042China Department of Critical Care Medicine Fourth Medical Center of the Chinese PLA General HospitalBeijing 100048China Department of Anesthesiology Nanfang HospitalSouthern Medical UniversityGuangzhou 510515China Department of Critical Care Medicine and Hematology the Third Xiangya HospitalCentral South UniversityChangs

Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed.Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire.Then,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions.This consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good consistency.After summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were produced.Finally,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this consensus.In summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

关键词： Sepsis Immune function monitoring Immunomodulatory therapy Immunosuppression

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