
Ernest E MooreUniversity of Colorado | UCD · Department of Surgery
Ernest E Moore
MD
About
2,525
Publications
473,318
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
109,886
Citations
Introduction
Postinjury fibrinolysis
Postinjury platelet dysfunction
Hemoglobin based oxygen carriers
Role of 5-lipoxygenase in postinjury MOF
Mesenteric lymph as a mechanistic link to MOF
Trauma induced coagulopathy
Plasma first resuscitation
Resuscitative thoracotomy / REBOA
Blunt carotid injury
Pelvic fracture bleeding
Additional affiliations
June 1976 - present
Ernest E Moore Shock Trauma Center at Denever Health
Position
- Director of Surgical Research Enest E Moore shock Trtauma Cnetre at Denevr Health
June 1968 - July 2021
July 1972 - June 1976
Publications
Publications (2,525)
Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restor...
Since December 2019, the world is potentially facing one of the most difficult infectious situations of the last decades. COVID-19 epidemic warrants consideration as a mass casualty incident (MCI) of the highest nature. An optimal MCI/disaster management should consider all four phases of the so-called disaster cycle: mitigation, planning, response...
Abstract Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the ris...
Background
COVID-19 threatens to quickly overwhelm our existing critical care infrastructure in the USA. Systemic tissue plasminogen activator (tPA) has been previously demonstrated to improve PaO 2 /FiO 2 (mmHg) when given to critically ill patients with acute respiratory distress syndrome (ARDS). It is unclear to what extent tPA may impact popula...
Background
The aim of this study was to determine the current utilization patterns of resuscitative endovascular balloon occlusion of aorta (REBOA) for hemorrhage control in nontrauma patients.
Methods
Data on REBOA use in nontrauma emergency general surgery patients from six centers, 2014-2019, was pooled for analysis. We performed descriptive an...
Background
Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbid...
Objectives:
Identify the metabolites that are increased in the plasma of severely injured patients that developed ARDS versus severely injured patients that did not, and assay if these increased metabolites prime PMNs and induce pulmonary sequestration in an animal model of ARDS. We hypothesize that metabolic derangement due to advanced shock in c...
The definition of hyperfibrinolysis based on thrombelastogram LY30 measurements should vary with trauma patient characteristics, i.e., as anatomic injury or shock severity increase, the ability to tolerate even mild degrees of fibrinolysis is markedly reduced. This trend is independent of institutional practice patterns. The management of hyperfibr...
Background
Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC.
Materials and methods
The WSES president appointed four members...
Trauma-induced coagulopathy (TIC) manifests as a bimodal disruption of normal fibrinolysis, where at the two extremes, fibrinolytic shutdown (TICFS) places the patient at increased risk for thromboembolism and post-injury multiple organ failure, and systemic hyperfibrinolysis (TICHF) results in excessive bleeding. Plasma proteomic profiles for 65 t...
Background
Venous thromboembolism chemoprophylaxis (VTE-CHEMO) is often delayed in patients with traumatic brain injury because of the concern for intracranial hemorrhage (ICH) progression. We hypothesize that (1) late time to VTE-CHEMO (≥48 h) is associated with higher incidence of VTE, and (2) VTE-CHEMO use does not correlate with ICH progression...
Objective:
To address the clinical and regulatory challenges of optimal primary endpoints for bleeding patients by developing consensus-based recommendations for primary clinical outcomes for pivotal trials in patients within 6 categories of significant bleeding, (1) traumatic injury, (2) intracranial hemorrhage, (3) cardiac surgery, (4) gastroint...
Injury is the leading cause of death worldwide [1], and the third leading cause of mortality in the United States [2]. Despite advances in emergency medical systems and trauma care, deaths from injury have increased in the United States over the last decade [3]. In both the civilian [4] and military [5] settings, uncontrolled hemorrhage is the lead...
Fibrinogen is converted by thrombin to form fibrin which makes up the structure of the hemostatic clot. Fibrinogen is the most abundant plasma clotting factor, yet it is also among the most labile. After trauma, hemodilution, hypothermia, and acidosis, in addition to enzymatic consumption and degradation, can contribute to rapid fibrinogen depletio...
Abdominal vascular trauma accounts for a small percentage of military and a moderate percentage of civilian trauma, affecting all age ranges and impacting young adult men most frequently. Penetrating causes are more frequent than blunt in adults, while blunt mechanisms are more common among pediatric populations. High rates of associated injuries,...
The peripheral arteries and veins of the extremities are among the most commonly injured vessels in both civilian and military vascular trauma. Blunt causes are more frequent than penetrating except during military conflicts and in certain geographic areas. Physical examination and simple bedside investigations of pulse pressures are key in early i...
Derangement of fibrinolysis has been an interest of surgical scientists for over 200 years. Appreciation of the spectrum of fibrinolysis following severe injury confirms the long-perceived notion that pathology occurs at the extremes of any protease system. Trauma can provoke overactivation of fibrinolysis resulting in uncontrolled bleeding or inhi...
Hemorrhage has been implicated as the cause of 25–30% of all injury deaths and over 80% of preventable postinjury deaths, both in the military and civilian settings. Hemorrhagic deaths are acute events, happening within the first 24 hours postinjury, mostly within 6 hours. While some studies observed a reduction in overall deaths due to exsanguinat...
Fibrinolysis is a normal physiologic process that is essential to maintain microvascular patency by removing extraneous fibrin clot [1]. The extremes of fibrinolysis, termed hyperfibrinolysis (excessive breakdown of clot) and fibrinolysis shutdown (resistance to clot breakdown), are associated with increased mortality [1, 2]. The mechanisms and cli...
Background:
Use of the Focused Assessment with Sonography for Trauma (FAST) exam in patients with pelvic fractures has been reported as unreliable. We hypothesized that FAST is a reliable method for detecting clinically significant intra-abdominal hemorrhage in patients with pelvic fractures.
Methods:
All patients with pelvic fractures over a 10...
Background
Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity. The World Society of Emergency Surgery (WSES) conceived this position paper with the purpose of providing recommendations for the management of surgical, infected and non-infected, patients...
Introduction:
Resuscitative thoracotomy (RT) is life-saving in select patients and can be accomplished through a left anterolateral (AT) or clamshell thoracotomy (CT). CT may provide additional exposure facilitating certain operative procedures, but the added blood and heat loss and time to perform it may increase complications. No prospective mul...
Background:
Trauma patients with hyperfibrinolysis and depletion of fibrinolytic inhibitors(DFI) measured by thrombelastography(TEG) gain clot strength with TXA, but TEG results take nearly an hour. We aimed to develop an assay, plasmin TEG(P-TEG), to more expeditiously stratify risk for massive transfusion(MT), mortality and hyperfibrinolysis.
M...
Introduction:
Current procedural terminology (CPT) codes for surgical stabilization of rib fractures (SSRF) are based solely on the number of ribs fixed, tricotomized at 1-3, 4-6, and ≥ 7. Our objective was to validate CPT codes against operative time at our institution, as well as further stratify complexity by rib fracture location and surgical...
Introduction:
Evidence supports the use of plasma-first resuscitation in the treatment of trauma-induced coagulopathy (TIC). While thawed plasma (TP) has logistical benefits, the ability of plasma proteins to attenuate fibrinolysis and correct TIC remain unknown. We hypothesize that TP retains the ability to inhibit tissue plasminogen activator(tP...
Background
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular adjunct to hemorrhage control. Success relies on institutional support and focused training in arterial access. We hypothesized that hospitals with higher REBOA volumes will be more successful than low-volume hospitals at aortic occlusion with REBOA.
Me...
Acute care surgery (ACS) refers to the surgical management of serious, emergency conditions, requiring some form of immediate surgical care or intervention. Essentially ACS should offer the surgeon the opportunity to perform a working diagnosis, to intervene appropriately and thereby to promptly have an impact on the outcome of the critically ill p...
Coagulopathy may be a life-threatening complication of any emergent operation. This is particularly relevant with the aging population who frequently are consuming preoperative anticoagulation or antiplatelet therapy. The most effective method to avoid coagulation-related complications is to obtain an accurate list of medications and their specific...
Introduction:
Surgical stabilization of rib fractures (SSRF) remains a relatively controversial operation, which is often deferred due to concern about expense. The objective of this study was to determine the charges for SSRF versus medical management during index admission for rib fractures. We hypothesize that SSRF is associated with increased...
Objectives:
To evaluate the relationship between timing of definitive fixation, injury severity, and the development of systemic complications in severely injured patients with pelvic ring injuries.
Design:
Retrospective review.
Settings:
Level 1 trauma center.
Patients:
One hundred eighteen severely injured [Injury Severity Score (ISS) ≥ 16...
Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which pre...
Background
Young-Burgess classification (YB) is a mechanistic system which classifies pelvic ring injuries into anterior-posterior compression (APC), lateral compression (LC), vertical shear (VS) injuries, and combined mechanism (CM). The objective of this study was to identify associated injuries which require urgent operative intervention by YB c...
Background
Venous thromboembolism (VTE) in patients with major pelvic fractures who undergo preperitoneal pelvic packing (PPP) has not been investigated. We hypothesized that patients who undergo PPP are at high risk for VTE, thus early prophylactic anticoagulation and screening duplex are warranted.
Study design
All patients requiring PPP from 20...
: Trauma with hemorrhagic shock causes massive tissue plasminogen activator release, plasmin generation, and hyperfibrinolysis. Tranexamic acid (TXA) has recently been used to treat bleeding in trauma by preventing plasmin generation to limit fibrinolysis. Trauma patients also have increased complement activation that correlates with mortality and...
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) was first described in the 1950s, but early attempts at REBOA faced several technical challenges. Subsequent advances in endovascular technologies led to renewed interest in employing REBOA for management of hemorrhagic shock. However, REBOA usage remains infrequent, and indications...
Background
Most remote areas have restricted access to health care services and are too small and remote to sustain specialist services. In 2017 the World Society of Emergency Surgery published the guidelines for the management of intra-abdominal infections. Many hospitals, especially in remote areas, continue to have logistic barriers leading to a...
This algorithm was designed to provide comprehensive and clear guidance aimed at reducing the VTE rate after trauma. Although there are multiple factors that will lead to deviations from the presented algorithm, most trauma patients should be initiated on early and higher doses of enoxaparin that often should be adjusted by anti-Xa levels. For most...
Background:
The lack of an accurate marker of prehospital hemorrhagic shock limits our ability to triage patients to the correct level of care, delays treatment in the emergency department, and inhibits our ability to perform prehospital interventional research in trauma. End tidal carbon dioxide(ETCO2) is the measurement of alveolar carbon dioxid...
Objective:
To describe the current use of the ER-REBOA catheter and associated outcomes and complications.
Introduction:
Noncompressible truncal hemorrhage is the leading cause of potentially preventable death in trauma patients. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a novel strategy to obtain earlier temporary hem...
The World Society of Emergency Surgery promotes training and continuing medical education in the field of emergency surgery and trauma. One of the most important activities of the society is the development of guidelines. The debate about the process of developing and updating guidelines is very active with no clear consensus and different policies...
Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available...
Background
Coronavirus disease 2019 (COVID-19) predisposes patients to a prothrombotic state with demonstrated microvascular involvement. The degree of hypercoagulability appears to correlate with outcomes, however optimal criteria to assess for the highest risk patients for thrombotic events remain unclear; we hypothesized that deranged thromboela...
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented stresses on modern medical systems, overwhelming the resource infrastructure in numerous countries while presenting a unique series of pathophysiologic clinical findings. Thrombotic coagulopathy is common in critically ill patients suffering from COVID-19, with associated hig...
Background
The COVID‐19 pandemic has caused a large surge of acute respiratory distress syndrome (ARDS). Prior phase I trials (non COVID‐19) demonstrated improvement in pulmonary function in ARDS patients using fibrinolytic therapy. A follow‐up trial using the widely available tissue‐plasminogen activator (alteplase) is now needed to assess optimal...
The COVID‐19 pandemic has caused respiratory failure and associated mortality in numbers that have overwhelmed global health systems. Thrombotic coagulopathy is present in nearly three‐quarters of COVID‐19 patients admitted to the intensive care unit, and both the clinical picture and pathologic findings are consistent with microvascular occlusive...
We read with interest the International Society on Thrombosis and Hemostasis interim guidance on recognition and management of coagulopathy in COVID‐19 (1). We applaud this group’s efforts in releasing a timely article on the pandemic impacting all regions of the globe. While we agree that this interim guidance addresses important considerations fo...
Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first c...
A hallmark of severe COVID‐19 is coagulopathy, with 71.4% of patients who die of COVID‐19 meeting ISTH criteria for disseminated intravascular coagulation (DIC) while only 0.6% of patients who survive meet these criteria (1). Additionally, it has become clear that this is not a bleeding diathesis but rather a predominantly pro‐thrombotic DIC with h...
Background:
While tissue injury provokes fibrinolysis shutdown in trauma, the mechanism remains elusive. Cellular death causes release of structural proteins, including actin and myosin, which may interact with clot formation and structure. We hypothesized that tissue injury is associated with high circulating actin and that actin produces a hyper...
Purpose of Review
The purpose of this review is to briefly outline the current state of hemorrhage control and resuscitation in trauma patients with a specific focus on the role viscoelastic assays have in this complex management to include indications for use across all phases of care in the injured patient.
Recent Findings
Viscoelastic assay use...
Trauma patients present to the emergency department with a spectrum of fibrinolytic activity. This wide variance in fibrinolysis activity is a complex multifactorial process impacted by the degree of hemorrhagic shock and the amount of tissue injury the individual sustains. The fibrinolytic activity of the trauma patient at presentation to the hosp...
Whole blood (WB) has been used for more than a century for far-forward combat resuscitation. Following the Iraq/Afghanistan combat, maritime, and austere environment use of WB for the resuscitation of severely hemorrhaging patients, there has been an increasing use of WB for the civilian urban resuscitation environment population. The impetus for t...
The global pandemic of COVID-19 has begun to oversaturate the world's medical capacity to accommodate a large surge of patients with acute respiratory distress syndrome (ARDS). Acute respiratory distress syndrome has no effective treatment besides supportive care, with the use of ventilatory strategies encompassing low tidal volumes that limit tran...
Background:
Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection...
Background:
Randomized clinical trials(RCTs) support the use of pre-hospital plasma in traumatic hemorrhagic shock, especially in long transports. The citrate added to plasma binds with calcium, yet most pre-hospital trauma protocols have no guidelines for calcium replacement. We reviewed the experience of two recent pre-hospital plasma RCTs regar...
Pelvic ring injuries presenting in hemorrhagic shock have historically had a mortality rate greater than 30%. To address this high mortality rate our institution has had a multi-disciplinary protocol for hemodynamically unstable pelvic ring injuries since 1993. In 2004, this protocol was revised to prioritize pre-peritoneal pelvic packing over angi...
Patients presenting with hemodynamic instability associated with pelvic fractures continue to have very high mortality and surgeons continue to seek damage control strategies that may improve survival. Strategies usually require massive transfusion, immediate pelvic stabilization and another adjunctive maneuver's such as angioembolization or preper...
Background:
Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a...
Variability in care in emergency surgery is well known, particularly in abdominal surgery, and reducing it is fundamental to improving outcomes. It is therefore vital to identify the factors that are key to improving mortality and reducing complications in various surgical emergencies. Under the leadership of the World Society of Emergency Surgery,...
BACKGROUND: Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. MATERIALS AND METHODS: The WSES president appointed four member...
Hot Topics in Acute Care Surgery and Trauma
Importance
Both military and civilian clinical practice guidelines include early plasma transfusion to achieve a plasma to red cell ratio approaching 1:1 to 1:2. However, it was not known how early plasma should be given for optimal benefit. Two recent randomized clinical trials were published, with apparently contradictory results. The Prehospital...
Background:
Hypertonic saline (23.4%, HTS) bolus administration is common practice for refractory intracranial hypertension, but its effects on coagulation are unknown. We hypothesize that 23.4% HTS in whole blood results in progressive impairment of coagulation in vitro and in vivo in a murine model of traumatic brain injury (TBI).
Study design:...
Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injurie...
Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients whe...
Background:
Most blunt splenic injuries (BSI) are treated with nonoperative management (NOM) or embolization (EMBO). Little is known about the hematologic changes associated with these treatments. We aim to assess the temporal changes of hematologic markers in trauma patients who undergo splenectomy (SPL), packing and splenorrhaphy (P/S), EMBO, or...
Abstract The acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided...
The liver is the most commonly injured solid organ in blunt trauma, and is frequently involved in penetrating trauma. This review covers initial evaluation, imaging and injury grading, operative exposure, hemorrhage control, definitive management of injuries, postoperative care, and complications and mortality. Figures show computed tomographic (CT...
Background
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality.
Method...
Background:
Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG® 5000 system is widely used for viscoelastic testing. However, the TEG® 6s system incorporates newer technology, with encouraging results in cardiovascular interventions...
Background:
Both hyperfibrinolysis and fibrinolysis shutdown can occur after severe trauma. The subgroup of trauma patients with fibrinolysis shutdown resistant to tissue plasminogen activator (t-PA)-mediated fibrinolysis have increased mortality. Fibrin polymerization and structure may influence fibrinolysis subgroups in trauma, but fibrin archit...
The original article [1] contained a typo in author, Federico Coccolini’s name. This has now been corrected.