NMRC

NeuroTrauma Deparment

medics treat a combat casualtyThe NeuroTrauma Department conducts research on a variety of topics pertinent to the protection, care, and resuscitation of combat casualties, primarily those occurring in austere circumstances with anticipated delay to definitive care. Specific issues being explored contribute to the search for an optimal resuscitation fluid, prolongation of survival, the development of blood component substitutes, and the development/study of animal models of militarily relevant injuries and optimizing mechanisms for their diagnosis and consequent care.

The Hematomimetics Program evaluates hemoglobin-based oxygen carriers (HBOCs) for resuscitation of hemorrhagic shock casualties in controlled hemorrhagic shock and liver crush/laceration and iliac arteriotomy/venotomy uncontrolled hemorrhagic shock models with or without concomitant traumatic brain injury (TBI) in swine (currently evaluating bovine polymerized hemoglobin). The goals of this program are to evaluate and optimize HBOCs in clinical trials for the resuscitation of hemorrhagic shock patients; to develop a whole blood-like Multifunctional Blood Substitute (MBS) that incorporates oxygen carrying capacity, procoagulant, anti-inflammatory, and anti-redox properties; and to improve resuscitation [currently looking at infusible platelet membranes (platelet substitute), recombinant factor VIIa (coagulation factor substitute), and Polyheme-SOD-catalase [HBOC cross-linked with superoxide dismutase and catalase (antiredox)].

The goals of the Basic Sciences Program are to develop treatment regimens to depress metabolic rate and prolong survival (hypothermia); characterize natural states of tolerance to hypoxia, such as hibernation (increased melatonin synthesis); identify pharmacological methods to modulate hemorrhage-induced tissue damage (gene silencing; anti-apoptosis); and develop militarily relevant models of combat injury for establishing better methods of diagnosis and treatment (hemorrhagic shock with and without concomitant head injury).

The Operational Medicine Program works closely with U.S. Marine Corps Operational and Research & Development commands to identify and effectively mitigate the effects of operational stressors negatively affecting U.S. Marines. This program maintains flexible delivery capabilities required by the rapidly evolving Expeditionary Warfare requirements. Current areas of research involve testing QuikClot, a zeolite haemostatic agent, for its ability to control hemorrhage and reduce mortality in a complex groin injury model. Also, a novel research capability has been established in blast biophysics and physiology to characterize pulmonary and CNS injury following blast exposure. Over 60 percent of military personnel returning from Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) to the Walter Reed Army Medical Center (WRAMC) have had blast-induced TBI with an increased recognition of long-term neurological consequences. Research has developed and characterized pulmonary and central nervous system injury in response to exposure to blast. This research focuses on a multidisciplinary approach to characterize the injury cascade and to develop intervention strategies for blast-related injury. An area of special interest is to develop concepts for medical management in urban operations. This program is a recognized international leader in efforts to determine the medical consequences of novel explosive devices with the purpose of developing guidance and therapy for managing casualties in military operations and domestic terrorism.