About

Jeremy W Cannon, MD, is a Professor of Surgery at the Hospital of the University of Pennsylvania and the Presbyterian Medical Center of Philadelphia. He is an active surgeon affiliated with the Philadelphia Veterans Affairs Medical Center, Penn Presbyterian Medical Center, and Pennsylvania Hospital. Dr. Cannon also serves as an Attending Surgeon at the Hospital of the University of Pennsylvania and is a Senior Fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. His clinical expertise includes trauma surgery, surgical critical care, and emergency general surgery, with specific focus on trauma resuscitation, damage control surgery, and management of vascular injuries. Dr. Cannon's research interests encompass mechanistic modeling, trauma resuscitation, decision support, and extracorporeal life support. He has contributed to the field through various publications and is involved in multiple professional committees, including awards of excellence and promotion committees at the Perelman School of Medicine. Dr. Cannon's educational background includes a BS in Biochemistry from the United States Air Force Academy, an MD from Harvard Medical School, and an SM in Mechanical Engineering from the Massachusetts Institute of Technology. His work emphasizes advancing trauma care, surgical critical care, and health economics, with a focus on improving patient outcomes through innovative research and clinical practice.

Research topics

• Medicine
• Surgery
• Intensive care medicine
• Emergency medicine
• Medical emergency

Selected publications

• Immersive Virtual Reality Simulation for Technical Skills Acquisition in Pneumothorax Management and Chest Tube Insertion: A Randomized Controlled Trial Among Surgery Interns

  SSRN Electronic Journal · 2026-01-01

  preprintOpen access
  PublisherDOI

• Hemostatic Tough Adhesives seal tissue and control hemorrhage

  Nature Communications · 2026-04-08

  articleOpen access

  Hemorrhage from internal organs remains a critical challenge in both trauma care and surgical procedures, as existing hemostatic adjuncts frequently fail to provide consistent and effective bleeding control, particularly under conditions of active bleeding or impaired coagulation. Here, we develop and evaluate a Hemostatic Tough Adhesive (HTA) in controlled preclinical models of traumatic solid organ injury and compare its performance against leading commercially available hemostatic agents. The HTA consistently outperformed its counterparts, achieving 100% hemostasis in both liver and spleen injuries within an in vivo preclinical porcine model. In contrast, existing adjuncts exhibited variable and often incomplete efficacy. Beyond immediate hemostasis, the HTA demonstrated prolonged stability and biocompatibility during the postoperative wound healing phase. Notably, the HTA exhibited tissue surface adhesion energy several orders of magnitude greater than that of current hemostatic products, indicating its potential utility for surgical and trauma-related bleeding management.

  PublisherDOI

• The <scp>THOR</scp> network best practices for females of childbearing potential with life‐threatening hemorrhage: Guidance for emergency medical services and hospitals

  Transfusion · 2026-03-07

  articleOpen access

  Hemorrhagic shock is a leading cause of early death from trauma and preventable mortality, including females of childbearing potential (FCP).1-3 A FCP is defined as a female child or adult who can become pregnant. Advances in resuscitation of patients with life-threatening hemorrhage have been associated with improved outcomes.1, 2 This has led to the concept of “damage control resuscitation,” which includes “hemostatic resuscitation”, a balanced blood-based resuscitation with either Low-Titer Group O+ Whole Blood LTOWB or blood components.4, 5 The use of LTOWB in the United States (US) has grown exponentially since the Trauma, Hemostasis, and Oxygenation Research (THOR) Network proposed a change to the Association for the Advancement of Blood & Biotherapies (AABB) standards in 2017, allowing its use for all etiologies of life-threatening hemorrhage.6 In 2014, no US trauma centers used LTOWB, and by 2024, over 300 had incorporated it into their clinical practice.7 Prehospital Emergency Medical Services (EMS) systems are also increasingly integrating blood transfusion into protocols for the treatment of life-threatening hemorrhage. This includes both RhD-positive LTOWB and Red Blood Cells (RBCs).8 In the US, approximately 60%–75% of air transport systems utilize blood products prehospital, and approximately 1%–2% ground transport systems carry blood products.9 Although LTOWB is safe, effective, and approved for emergency use when type-specific blood is unavailable, potential ethical considerations for the use of RhD-positive LTOWB or RBCs persist for RhD-negative FCP due to the long-term risk of future alloimmunization, which must be weighed against the short-term risk of death from life-threatening hemorrhage.10, 11 While there are advantages to the use of LTOWB and RBCs in the prehospital setting, there are nuanced challenges and concerns, particularly for RhD-negative FCP, where introduction of RhD-positive blood products can cause anti-D alloimmunization. Alloimmunization is the process by which a patient's immune system forms antibodies against foreign antigens found on transfused blood cells or tissues that the patient's own cells do not recognize.12-14 It can occur by transfusing RhD-positive blood products that contain red blood cells (LTOWB or RBC units) to RhD-negative FCP, posing a potential risk of hemolytic disease of the fetus and newborn (HDFN) in future pregnancies.15, 16 Alloimmunization occurs when a patient's immune system produces antibodies against foreign antigens (proteins on the surface of cells) from transfused blood that differ from the patient's blood type. Practically speaking, the body's immune system “remembers” proteins on foreign blood and mounts a defense against the same proteins in the future. The use of RhD-negative LTOWB or RBCs would obviate this risk; however, the demand for these products far exceeds the supply of these scarce resources. Approximately 3%–4% of the US population can potentially donate Type O-negative products, based on Group O Rh-negative prevalence of approximately 7%–8%, and between 70% and 95% of donors meeting low titer criteria (Anti-A and B <256).17 Advances in maternal–fetal medicine have substantially reduced the morbidity and mortality associated with HDFN; however, monitoring and interventions remain highly specialized, requiring coordinated perinatal services outlined in the THOR Network and Allo Hope Foundation's recommendations on the optimal treatment of alloimmunized pregnant patients and the postnatal treatment of affected neonates.18 In emergencies involving life-threatening hemorrhage, immediate transfusion is critical for survival, and surveys suggest that many female respondents and caregivers would prioritize life-saving RhD-positive transfusion when RhD-negative products are unavailable, recognizing that the small subsequent risk of severe or fatal HDFN can be further significantly reduced with proactive guidance and optimal care.19-21 Recent evidence challenges the long-held assumptions regarding the risk of hemolytic disease of the fetus and newborn (HDFN) following RhD-positive transfusion. Traditionally, concerns about D-alloimmunization in FCP led to strict avoidance of RhD-positive products. However, contemporary data suggest this risk is much lower than previously thought: Several sequential events must occur to result in the development of severe (including fatal) hemolytic disease of the fetus and newborn (HDFN). Multiple models have examined the overall risk of HDFN in RhD-negative females of childbearing potential who are resuscitated with RhD-positive transfusion. One such model estimated one case of fetal death or permanent disability due to HDFN per 670 transfusions (~0.15%); another estimated a 0.04% chance of perinatal death due to HDFN and a 0.24% chance of death or other serious adverse event.8, 22 The data support a pragmatic and risk-based approach in emergency situations where the immediate need for transfusion outweighs the long-term alloimmune complications (Figure 1).13 The implementation of LTOWB has not been equitable between males and females with life-threatening hemorrhage. Upon adjusted analyses, FCP were 40% less likely to receive LTOWB than males.23 A growing body of evidence supports the prehospital use of group-O-positive blood products in life-threatening hemorrhage of any etiology for FCP when RhD-negative products are unavailable, provided that post-exposure antibody screening and appropriate education and counseling are ensured. Standardized informational documents for informing FCP regarding the risk of alloimmunization after exposure and guidance for what to do if alloimmunized are found in Appendices A and B. Recommendations from evidence-based guidelines organized by THOR Network and the Allo Hope Foundation, sponsored by the US Department of Defense state, “We recommend the use of RhD-positive blood products for the initial resuscitation of patients with life-threatening hemorrhage when RhD-negative blood products are not available, regardless of patient age or sex” and “We suggest the use of RhD-negative LTOWB for the initial resuscitation of ABO-type unknown female patients with life-threatening hemorrhage.24 If unavailable or impractical, we suggest the use of RhD-positive LTOWB”. Similar recommendations are further highlighted in the Prehospital Transfusion Coalition's Clinical Practice Guidelines for Civilian Emergency Medical Services.8 The rationale justifying the use of RhD-positive LTOWB or RBCs is that there is the potential for improved survival. Earlier use of LTOWB, plasma and RBCs for severe bleeding has been associated with improved survival and a decreased overall requirement for additional transfusions.25-27 However, delays in identifying and treating life-threatening hemorrhage continue to contribute to preventable deaths, which mostly occur in the prehospital phase of resuscitation.28 LTOWB offers a practical solution for prehospital care by combining red blood cells (RBCs), plasma, and platelets in a single unit.29-31 For both prehospital and hospital resuscitation of life-threatening hemorrhage, LTOWB is at least as effective, and logistically superior, compared to component therapy (CT), reducing donor exposures while enabling a more rapid and balanced resuscitation.30, 32-34 Based on data in a meta-analysis of close to 60,000 patients, LTOWB may improve outcomes compared to components when used for hospital-based resuscitation.30 This best-practices document aims to assist EMS systems and hospitals in establishing streamlined processes for managing the use of prehospital blood in cases of life-threatening hemorrhage involving FCPs. Establishing clear protocols for communication among EMS, hospital care providers, and blood banks is essential to ensure patient safety, promote system-wide performance improvement, minimize waste, and enhance clinical outcomes.8, 11, 14 Through these best practices, we aim to strengthen collaboration frameworks that align ethics, operations, and outcomes across the trauma continuum—ultimately improving patient care and system efficiency. This guidance includes early field recognition of hemorrhage and rapid initiation of balanced resuscitation, EMS-to-hospital handoffs, and post-exposure follow-up and education. Early recognition and treatment of hemorrhagic shock can improve patient survival. Physiologic indicators, such as hypotension and tachycardia, as well as additional metrics, including shock index, end-tidal capnography trends, point-of-care lactate (when available), and ultrasound, help identify hemorrhagic shock.1-3 Initiating blood products as soon as possible is associated with lower mortality as compared to crystalloid-based strategies, particularly when transport times are prolonged or hemorrhage control is difficult or delayed.1 As stated above, for FCP patients, RhD-negative LTOWB is ideal; however, scarcity necessitates a risk-stratified approach.10, 15, 23 The potential for sex-based inequity by withholding prehospital blood products or defaulting to scarce RhD-negative red cell-only transfusions for women, while men receive LTOWB, serves to intentionally widen survival gaps.10, 15, 23 Pediatric specific gender based inequity data have not been published as of this manuscript's writing. Fair access frameworks prioritize LTOWB for any patient in critical condition, while conserving scarce RhD-negative inventories through system stewardship and, when possible, appropriate switching to RhD-positive blood products within a given resuscitation timeline when blood type and screen have resulted.10, 34 Ethically, the risk–benefit calculations favor transfusing available (RhD-positive) blood prehospital in cases of exsanguination regardless of RhD status.10, 33, 34 In a life-threatening hemorrhage when RhD-negative blood is unavailable, RhD-positive LTOWB (or RBCs) are appropriate to preserve life.27 The EMS-to-hospital handoff of care is a critical juncture for ensuring patient safety following a transfusion event.35 See Figure 2 for an example of a form used by the Southwest Texas Regional Advisory Council (STRAC) that standardizes this process. It is essential that patient handoff from EMS to hospital-based teams provide detailed documentation and closed-loop communication with care team members of all care provided to specifically include the transfusion of any RhD-positive blood product to a FCP. Hospitals should establish procedures to accept and store prehospital unit segments for post-event testing, record all uncrossmatched transfusions administered in the field, and have immediate notification pathways for suspected reactions, even if the blood originated from an external blood bank.27 Policies and procedures should be developed jointly with the prehospital agency serving as the Transfusion Administration Service (TAS).30 Electronic medical records systems should allow prehospital transfusion data to be directly entered into the hospital transfusion service record.8 If direct entry isn't possible, paper records should be used and provided by the prehospital agency to ensure accurate documentation of transfusion data.36 Rh immunoglobulin (RhIg) is only recommended after small-volume (≤one unit) RhD-positive LTOWB or RBC transfusions in RhD-negative FCPs. When indicated, administration can occur up to 72 h post-exposure.31, 37 There is no role for RhIg for males or postmenopausal females.38, 39 Additional clinical considerations related to RhIg prophylaxis include the risk of severe hemolysis from rapid administration of large RhIg volumes (estimated 17–20 vials per RBC/LTOWB unit), as well as complexity in interpreting subsequent antibody screens (passive vs. allo-anti-D).37 Logistical considerations include prioritization strategies given supply chain and manufacturing limitations related to RhIg shortages.40 All RhD-negative FCPs exposed to RhD-positive LTOWB and RBCs should receive informational literature (1 and 2) and clear discharge documentation describing post-exposure implications and follow-up recommendations (Figure 3), including care coordination to facilitate scheduled antibody screening (e.g., 14 weeks to 6 months), as well as prior to, or early in, subsequent pregnancies, with results communicated to patients, outpatient clinicians, and maternal-fetal medicine specialists.8, 10, 12, 41 Post-exposure patient management of the RhD-negative FCP following transfusion or exposure to RhD-positive blood should follow standardized pathways (Figure 3).11, 12 EMS and hospital system best practices include the following (Table 1).1-4, 8, 19, 27-34 Implement life-threatening hemorrhage screening processes that trains clinicians to maintain a high index of suspicion based on mechanism of injury, systolic blood pressure, shock index, and point-of-care lactate. Establish prehospital blood (PHB) activation criteria and workflows so blood products can be initiated promptly when life-threatening hemorrhage is suspected. Ensure all relevant clinical personnel (including prehospital and in-hospital) receive education and competency validation on life-threatening hemorrhage recognition and intervention. Maintain reliable procedures for rapid vital sign assessment and assessment of shock. Initiate blood products as early as possible for life-threatening hemorrhage; avoid crystalloid-only resuscitation, as early blood product use is associated with lower mortality. Prioritize low-titer O whole blood (LTOWB) for initial resuscitation when available. If LTOWB is not available, transfuse liquid plasma and red blood cells (RBCs) together rather than either component alone. Define and follow criteria for transitioning from LTOWB to type-specific, crossmatched components once life-threatening hemorrhage has ceased and the patient's ABO type is known. When large-volume LTOWB resuscitation has occurred, transitioning to an ABO- compatible components is safe, and should be done so promptly when available. Administer Rh immunoglobulin (RhIg) to RhD-negative patients only after small-volume (≤1 unit) exposure to RhD-positive LTOWB or RBCs; do not routinely administer RhIg if more than 1 unit of RhD-positive LTOWB or RBCs was transfused during exsanguinating hemorrhage. In exsanguinating hemorrhage involving a FCP, do not delay transfusion when RhD-negative blood is unavailable; use RhD-positive LTOWB or RBCs to preserve life. Promote equitable access to PHB and LTOWB across all patient populations and care settings, with transparent policies that balance maternal-fetal considerations against immediate survival. Use closed-loop communication and document all blood products transfused to FCP across the care continuum (EMS through hospital discharge). Establish hospital procedures to accept and store prehospital unit segments for post-event testing, traceability, and documentation. Maintain real-time, bidirectional notification mechanisms between EMS, hospitals, and external blood suppliers for suspected transfusion reactions, including clear handoffs and escalation pathways. Provide standardized informational literature and counseling before discharge. Include exposure details and follow-up instructions in discharge documentation. Schedule antibody screening between 14 weeks and 6 months post-exposure. Ensure results are shared with the patient's outpatient clinicians (e.g., primary care, obstetrics/gynecology or maternal fetal medicine) and documented in the medical record for future pregnancies or transfusions. Registries should assess the cumulative burden of RhD alloimmunization, the percentage of individuals that develop high-titer antibodies, and related outcomes.12, 13, 34 Digital hemovigilance, which includes linking EMS records, hospital transfusion services, and regional blood banks, can enable real-time reaction detection, targeted recalls, and patient-specific counseling.8, 42 Over time, these networks can support pragmatic trials, equitable allocation models, and transparent public reporting. Multicenter trials (MATIC-2 NCT06070350, TROOP NCT05638581) are ongoing that will help to determine the impact of prehospital and in-hospital blood transfusion, specifically LTOWB, on mortality, transfusion efficiency, risk of alloimmunization in FCP who receive RhD-positive LTOWB and RBC, and adverse events in both pediatric and adult cohorts. Longitudinal tracking of alloimmunization and pregnancy outcomes after emergent RhD-positive exposure is a key research priority, as is the development of RBC antigen (RhD, K, E, etc.) agnostic future blood products.12, 13 The current development of RBCs produced from stem cells and artificial red cells is a promising product that could address this need.43 To improve survival in FCP suffering from life-threatening hemorrhage requires early recognition and immediate blood-based resuscitation. Because RhD-negative LTOWB or RBCs are not usually available, RhD-positive transfusion pathways after exposure begin with seamless EMS-to-hospital communication at the patient care transition, involving coordinated data sharing to enhance safety and accountability. By following standardized workflows, ensuring timely and safe transfusion practices, implementing transparent governance, and conducting structured follow-up and counseling, systems can optimize survival while ensuring long-term reproductive health. Through collaboration between EMS, specialized care, and transfusion medicine teams, a once-seemingly complex ethical dilemma has become a reproducible, evidence-based model for lifesaving best practices. Matthew J. Levy is a consultant with Stryker Medical Education and GMR. He is the chair of the Stop the Bleed Coalition. He is the EMS Medical Director of Continuing Education for the American Red Cross and is a member of the Scientific Advisory Council of the American Red Cross. John B. Holcomb is on the board of directors of QinFlow, Hemostatics, and Zibrio. He receives research grant support from the DoD and NIH, focused on hemorrhage control and resuscitation. He consults with WFIRM, Geneva Foundation, Aspen Medical, Infrascan, and is the coinventor of the Junctional Emergency Tourniquet Tool and thus receives royalties from UT Health. You received a blood transfusion with whole blood or red blood cells. This blood transfusion was provided emergently to help save your life. What is Rh(D)? Rh(D) is a protein found on the outside of red blood cells. If your blood has the protein, you are Rh(D) positive. If your blood does not have the protein, you are Rh(D) negative. The “+” or “-” you might see after your blood type shows if you are Rh positive or negative. You received a blood transfusion with a product called whole blood or RBCs. This blood transfusion was provided emergently to help save your life. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

  PublisherDOI

• Ketamine is Associated with Increased 24-Hour Mortality Following Traumatic Brain Injury Compared with Other Induction Medications, a Retrospective Study

  Neurotrauma Reports · 2026-01-01

  articleOpen access

  Ketamine is a dissociative anesthetic often used for airway management in trauma. While perceived to preserve hemodynamic stability, concerns exist regarding its effects on intracranial pressure and cardiac output in critically ill patients. There is a lack of studies evaluating outcomes after ketamine administration in the setting of traumatic brain injury (TBI). This study aimed to investigate the effects of ketamine on outcomes and physiological responses in a large cohort of TBI patients. We hypothesized that ketamine administration would not be associated with differences in survival, vital signs, or disposition outcomes compared with other induction medications when administered following TBI. This was a retrospective, observational study utilizing data from the Linking Investigations in Trauma and Emergency Services registry (2017–2021). Subjects were divided into two groups: those who received only ketamine ( n = 429) and those who received other induction medications (etomidate and/or propofol; n = 993). We compared 24-h mortality, initial in-hospital vital signs (systolic blood pressure [SBP], respiratory rate, heart rate, and Glasgow Coma Scale [GCS]), and hospital discharge disposition; a propensity score analysis adjusted for potential confounders including race, injury type, pre-hospital GCS, initial pre-hospital SBP and site location. Ketamine-exposed subjects were younger and presented with a worse clinical profile, including lower pre-hospital GCS (5 vs. 6, p &lt; 0.01) and lower SBP (126.5 vs. 144.0 mmHg, p &lt; 0.01) compared with the ketamine-unexposed group. Unadjusted analysis showed a significantly higher 24-h mortality rate in the ketamine-exposed group (3.5% vs. 1.4%, p = 0.02), as well as lower initial in-hospital vital signs. After propensity score adjustment, the odds of 24-h mortality remained significantly higher for the ketamine-exposed group (OR 2.358, p = 0.042). Hospital discharge disposition was not different between groups in any analysis. In this retrospective analysis, ketamine administration for pre-hospital airway management in TBI patients was associated with an increased 24-h mortality and lower in-hospital SBP, even after adjusting for baseline differences. However, injury severity and the length of time examined for mortality may explain the significant mortality association for ketamine in this study. Prospective studies are needed to examine the relationship between ketamine administration and mortality following TBI.

  PublisherDOI

• Timing of trauma deaths due to uncontrolled bleeding have not changed in three decades: A multicenter study of patients in hemorrhagic shock

  The American Journal of Surgery · 2025-07-15 · 7 citations

  article
  PublisherDOI

• Intent Versus Execution

  Annals of Surgery · 2025-06-17 · 3 citations

  article

  OBJECTIVES: To evaluate the adherence to balanced resuscitation in the first 4 hours, and how whole blood (WB) affected the achievement of these ratios. BACKGROUND: In 2014, TQIP Best Practices recommended balanced resuscitation in a 1:1:1 (RBC:FFP:PLT) ratio. A subsequent randomized trial demonstrated a reduction in mortality with 1:1:1 in hemorrhaging trauma patients. Adoption of these recommendations and study findings has yet to be evaluated. METHODS: A prospective, multicenter, observational cohort study was performed at 7 academic level-1 trauma centers. Injured patients who required both blood transfusions and hemorrhage control procedures were enrolled. The primary outcome was 4-hour ratios of RBC:FFP and RBC:PLT. Patients dying in the first 60 minutes were excluded. RESULTS: Of 1047 eligible patients, 1034 met the inclusion criteria. Overall, at 4 hours, 1:1 ratios for RBC:FFP and RBC:PLT were only achieved in 40% and 23%, respectively. Patients who achieved 1:1 for RBC:FFP (9% vs 22%) and RBC:PLT (13% vs 18%) at 4 hours had lower 28-day mortality rates; both P <0.05. Multivariate regression confirmed an associated reduction in mortality with achievement of 1:1 ratios of RBC:FFP (OR: 0.42, 95% CI: 0.25-0.68; P <0.001) and RBC:PLT (0.61, 95% CI: 0.37-0.98; P =0.044). In addition, WB was associated with an increased likelihood of achieving both RBC:FFP (OR: 2.8, 95% CI: 2.14-3.62) and RBC:PLT (OR: 3.4, 95% CI: 2.55-4.62) of 1:1; both P <0.001. CONCLUSIONS: In this prospective multi-institutional study, <50% of patients were resuscitated in a balanced fashion. The use of WB was associated with an increased likelihood of achieving balanced ratios. Unbalanced resuscitation was associated with decreased survival.

  PublisherDOI

• Acute Respiratory Distress Syndrome in Trauma 2007–2019: Comprehensive Patient and Center-Level Retrospective Cohort Analysis

  Critical Care Medicine · 2025-11-12 · 1 citations

  articleSenior author

  OBJECTIVES: Acute respiratory distress syndrome (ARDS) represents a significant complication in trauma patients. Yet the epidemiology of ARDS in trauma remains incompletely characterized. We sought to define trends in ARDS frequency and the effect of temporal, patient, and center-level factors on outcomes with the hypothesis that ARDS independently predicts mortality. DESIGN: Retrospective cohort study. SETTING: Hospitals submitting data to the American College of Surgeons National Trauma Data Bank. PATIENTS: Injured patients 18 years old or older from 2007 to 2019 on mechanical ventilation (MV) for greater than or equal to 2 days were included, and patients with ARDS were compared with those without ARDS. A subgroup with transfusion data was also identified. Multivariable logistic regression models by year adjusted for patient demographics, center characteristics, and blood products identified factors independently associated with ARDS diagnosis and 30-day hospital mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 384,032 injured patients on MV, ARDS was documented in 29,359 (8 per 100 MV patients) with a significant decrease over the study period (22 in 2007 vs. 3 in 2019, p < 0.001). Patient-level risk factors independently associated with ARDS were blunt injury (odds ratio [OR] 1.25; 95% CI, 1.20-1.30), severe sepsis (OR 2.16; 95% CI, 2.06-2.27), ventilator-associated pneumonia (OR 2.91; 95% CI, 2.82-3.00), and acute kidney injury (AKI, OR 2.98; 95% CI, 2.85 to 3.12). In the transfusion subset, 24-hour plasma (OR 1.02; 95% CI, 1.01-1.04) and platelets (OR 1.03; 95% CI, 1.02-1.05) were independently associated with ARDS. Crude ARDS mortality increased over the study period (2007, 15.1% vs. 2019, 29.7%, p < 0.001), and after adjusting for significant differences, ARDS was independently associated with 30-day hospital mortality (OR 1.32; 95% CI, 1.27-1.37). Independent risk factors for 30-day mortality in patients with ARDS included head injury (OR 1.54; 95% CI, 1.43-1.66), severe sepsis (OR 1.48; 95% CI, 1.34-1.63), and AKI (OR 2.72; 95% CI, 2.50-2.96). Patients with ARDS managed in Prevention and Early Treatment of Acute Lung Injury and the Extracorporeal Life Support Organization centers were less likely to die (OR 0.78; 95% CI, 0.72-0.84). CONCLUSIONS: From 2007 to 2019, ARDS decreased significantly in trauma patients. Over the same time, mortality increased to nearly 30%, and after adjusting for other risks factors, ARDS was strongly associated with 30-day mortality. Future studies should examine modifiable patient and center-level factors to improve mortality in these high-risk patients.

  PublisherDOI

• Assessing Technical Skills in the Trauma Bay: Benchmarking &amp; Creating Procedural Norms

  Current Trauma Reports · 2025-08-01

  articleOpen accessSenior author

  Proficiency in life-saving interventions is necessary to minimize morbidity and mortality in critically injured patients. The technical skills required to secure a difficult airway, insert an emergent tube thoracostomy, or to resuscitate a pulseless trauma patient develop over many years. Yet the training objective (i.e. the definition of success or technical mastery) often remains poorly defined. This review describes various approaches used to create norms around these and other common trauma bay procedures and the process by which to validate these norms as benchmarks against which performance can be measured. Approaches to assess technical skills in the trauma bay include direct observation and evaluation, simulation with real time assessment of procedures, and video review retrospective analysis of common trauma bay procedures. Approaches to benchmarking standards and developing procedural norms vary, but remain beneficial. The literature reports a plethora of assessment tools to evaluate technical skills in the trauma bay, with a heavy focus on trauma video review. To create standards for skill performance, procedural benchmarks should be established and evaluated repeatedly to monitor proficiency or mastery.

  PublisherOA PDFDOI

• Male Survival Disadvantage in Pulmonary Hypertension in the PVRI Godeep Meta-registry

  American Journal of Respiratory and Critical Care Medicine · 2025-05-01

  article

  Abstract Introduction Sex-based differences in morbidity and mortality for pulmonary hypertension (PH) are insufficiently addressed in current research. However, recognizing these differences is crucial for optimal clinical management and improving outcomes. This study assesses the effect of sex on survival among PH patients, while accounting for disease severity, comorbidities, treatment, and race. Methods We analyzed data from the PVRI GoDeep meta-registry, including all incident patients with complete hemodynamic profiles. Survival was evaluated using Kaplan-Meier and Cox proportional hazards models, adjusted for various confounders. Analyses included both PAH and non-PAH groups and risk assessment by the ESC/ERS 2022, REVEAL lite 2, and COMPERA 4-strata scores. All analyses were performed using R (The R Foundation). Results A total of 19,663 incident PH patients were included in the analysis, with 5,581 patients (28%) diagnosed with Group 1 PH and a median age of 64 years [IQR: 52-73]. Among these, male patients (8,704, 44%) had a significantly higher mortality risk than female patients across the entire cohort and within all PH subtypes. The adjusted hazard ratio for mortality in male versus female patients was 1.391 [95% CI: 1.260-1.536] in the overall population and 1.404 [95% CI: 1.264-1.561] for those with PAH. This survival difference was consistent across various severity levels, age groups, and in the presence of comorbidities such as obesity and cardiovascular diseases, as well as among those receiving PAH-specific therapies as well as patients who remained without treatment during the observation period. Notably, male disadvantage in survival was observed in low, intermediate, and high-risk categories for ESC/ERS 2022, REVEAL lite 2, and COMPERA scores but not within REVEAL 2.0, which includes male sex as a non-modifiable risk factor. Racial analysis revealed a greater mortality risk for males among White patients, with no significant differences noted in Black or Asian populations. Conclusion Our PVRI GoDeep meta-registry analysis demonstrates that male PH patients face higher mortality risk across both PAH and non-PAH groups, independent of disease etiology, age, severity, comorbidities, and treatment factors, with this risk amplified in White patients. These findings suggest that male sex should be further considered as a risk factor to refine predictive models for survival in PH.

  PublisherDOI

• Video Review Analysis of Early Femoral Arterial Access in Trauma: Does Early Identification of Occult Hemorrhagic Shock Make a Difference?

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

Recent grants

• NIH Grant F32HL068404

  NIH · $118k · 2003

Frequent coauthors

• Mark J. Seamon

  University of Pennsylvania

  113 shared

• Travis M. Polk

  103 shared

• Leopoldo C. Cancio

  United States Army Institute of Surgical Research

  95 shared

• Kenji Inaba

  University of Southern California

  85 shared

• Craig Goolsby

  84 shared

• Nicole Dacuyan-Faucher

  Harbor–UCLA Medical Center

  83 shared

• Keke Schuler

  Reliant Medical Group

  82 shared

• Curt S. Kothera

  Innovital Systems (United States)

  82 shared

Labs

• Cannon LabPI

Awards & honors

• Awards of Excellence Selection Committee, Pearlman School of…
• Committee on Appointments and Promotions, Perelman School of…