Patients with major burns require fluid to prevent dehydration, organ failure and death. Fluid for burns is typically given directly into the blood (i.e., intravenous or IV). However, Warfighters on the battlefield and others injured in remote and/or austere places frequently do not receive appropriate amounts of fluid immediately after injury because IV fluid resuscitation is complicated and requires advanced resources. A simpler, more operationally advantageous strategy for burn resuscitation is urgently needed to improve the outcomes of people burned in austere places like battlefields, ships, rural U.S., low- and middle-income countries.
Dr. Barclay Stewart (Assistant Professor of Surgery and Core Faculty of HIPRC), Dr. Adam Gyedu (Associate Professor of Surgery at Kwame Nkrumah University of Science and Technology, KNUST, in Ghana), Dr. Charles Mock (Professor of Surgery and Global Injury Section Lead at HIPRC) and their colleagues were awarded $ 1.5M by the Department of Defense to study enteral resuscitation for major burn injuries – Far Forward, Fluid First (4F) EnteroResus Study.
Giving fluid by mouth or through a feeding tube placed through the nose into the stomach to prevent or treat dehydration is called enteral resuscitation. It is particularly attractive because it can be provided by the patient themselves (by drinking), by a non-medical first responder (by a friend or bystander), or by a medical first responder (by a combat medic).
Dr. Stewart and his colleagues are going to perform a cluster-randomized, hybrid I effectiveness-implementation trial of enterally based- vs IV -resuscitation at 18 first-level hospitals in Ghana. All first-level hospitals will receive training in protocolized resuscitation, early burn care, and transfer criteria. All hospitals will also receive a ‘BurnBag’ with the resources required for enterally based- or IV- resuscitation per randomization. Researchers on this study aim to compare the effectiveness of enteral resuscitation in these resource limited facilities and identify challenges and facilitators to implementing enteral resuscitation, particularly those relevant to the Department of Defense.
The findings from this study may have significant impact and direct military benefit, early burn care, and resuscitation of people burned .
In the military, enteral resuscitation may:
The findings will also have important implications for the early burn care and resuscitation of people burned in the rural U.S. and in low- and middle-income countries, where 90% of all burn injuries occur. The study is designed to obtain valuable information about use of enteral resuscitation for burns in real-world and austere settings. By doing so, the team will be able to accelerate the uptake of enteral resuscitation, create effective implementation strategies, and inform burn care training programs in the military and beyond.