The incidence, outcome, and treatment of advanced organ failure and support after trauma: A review with implications for future large-scale combat operations.

Abstract: Future large-scale combat operations could involve delayed patient evacuation because of contested theaters of operations where United States and allied forces are unlikely to have air superiority. Prolonged casualty care could be more prevalent with delays in evacuation, requiring personnel prepared to provide critical care for injured warfighters and innovation aimed at supporting patients for longer periods of time. We conduct a review on the incidence and mortality rates of organ failure, describe the potential benefits of organ support, and offer recommendations to improve the care of patients in future conflicts. We performed a review examining the incidence and mortality of organ failure and the documented use of advanced modalities in the care of patients with organ failure. The search was conducted from the database's inception to June 21, 2024. Primary literature from previous review articles was also incorporated into this review. Authors reviewed relevant abstracts and full manuscripts. Acute respiratory failure and the need for respiratory support are common in severely injured trauma patients. Acute renal failure and the need for advanced renal support were also found to be common after injury. Although less common, advanced extracorporeal support, when required, can improve patient outcomes. In order to prepare for future conflicts, investment in personnel training, sustainment, and innovative technology will be essential to saving lives.

Level of evidence: Systemic Review; Level IV.