Effect of Remote Ischemic Conditioning on Trauma Patients With Hemorrhagic Shock

Inclusion Criteria

• Age ≥16 years of age or estimated weight ≥50kgs if age is unknown;
• Victim of blunt or penetrating trauma
• Hemorrhagic shock defined as:
• One or more episodes of systolic blood pressure ≤90mmHg at any time prior to enrollment into the study;
• An identified source of blood loss (abdomen, chest, pelvis/retroperitoneum, extremities, external) or
• Blood products (RBC, Platelets, Plasma, etc.) has been ordered to the trauma room.
• Admitted to St. Michael's Hospital directly from the scene of injury within 3 hours of the injury
• Application and completion of Remote Ischemic Conditioning (RIC) within 4 hours of the injury

Exclusion Criteria

• Pregnancy
• Non-hemorrhagic shock (i.e. tension pneumothorax, cardiac tamponade, spinal shock, etc.)
• Major burns > 20% total body surface area
• Fracture of both lower extremities (i.e. traumatic amputation, fractures)
• Absence of vital signs prior to admission, ongoing CPR, possibly dead on admission or not expected to survive beyond a few hours.
• Injury in both legs (traumatic amputation, fractures, etc.)
• Patients with a systolic blood pressure above 200mmHg
• Patients treated with anticoagulants, antiplatelet therapy (Warfarin, Aspirin), steroids or with a known bleeding disorder or known abnormality of blood flow to the limb (if known)
• Patients with osteoporosis or other bone disorders, peripheral nerve injury, abnormal nerve supply, peripheral neuropathy (if known) or preexisting traumatic injury to the limb.
• Morbid obesity (largest cuff size won't fit)
• If RIC is done clinically before research protocol begins.