Bio


Dr. Tobin received his biology degree from Dartmouth College, and worked as a paramedic while earning his Medical Degree at Boston University. He completed Anesthesiology Residency at the University of Washington, Critical Care Fellowship at Stanford and a sabbatical in Prehospital Medicine at Sydney Helicopter Emergency Medical Services (Sydney HEMS). Dr. Tobin earned his Master’s Degree in Biomedical Engineering at the University of Southern California. He is the founding president of the Trauma Anesthesiology Society, and his research interests include trauma resuscitation as well as critical care transportation. Dr. Tobin holds two U.S. patents and is the author of numerous peer reviewed scientific articles, textbook chapters and other manuscripts.

Dr. Tobin is also a Captain in the U.S. Navy Reserve. He has deployed as an intensivist on Critical Care Air Transport (CCAT) and Special Operations Critical Care Evacuation Teams (SOCCET), as the Critical Care Anesthesiology department head of the NATO Role 3 Trauma Hospital in Kandahar, Afghanistan and as the Command Surgeon of the NATO Special Operations Component Command - Afghanistan. CAPT Tobin’s awards include the Defense Meritorious Service Medal, Air Medal and Romanian Medal of Honor of the General Staff.

Academic Appointments


All Publications


  • Joint Trauma System Clinical Practice Guideline (JTS CPG): Prehospital Blood Transfusion. 30 October 2020. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals Voller, J., Tobin, J. M., Cap, A. P., Cunningham, C. W., Denoyer, M., Drew, B., Johannigman, J., Mann-Salinas, E. A., Walrath, B., Gurney, J. M., Shackelford, S. A. 2021; 21 (4): 11-21

    Abstract

    This Clinical Practice Guideline (CPG) provides a brief summary of the scientific literature for prehospital blood use, with an emphasis on the en route care environment. Updates include the importance of calcium administration to counteract the deleterious effects of hypocalcemia, minimal to no use of crystalloid, and stresses the importance of involved and educated en route care medical directors alongside at a competent prehospital and en route care providers (see Table 1). With the paradigm shift to use FDA-approved cold stored low titer group O whole blood (CS-LTOWB) along with the operational need for continued use of walking blood banks (WBB) and point of injury (POI) transfusion, there must be focused, deliberate training incorporating the different whole blood options. Appropriate supervision of autologous blood transfusion training is important for execution of this task in support of deployed combat operations as well as other operations in which traumatic injuries will occur. Command emphasis on the importance of this effort as well as appropriate logistical support are essential elements of a prehospital blood program as part of a prehospital/en route combat casualty care system.

    View details for PubMedID 34969121

  • Impact of Prehospital Airway Interventions on Outcome in Cardiac Arrest Following Drowning: a study from the CARES Surveillance Group. Resuscitation Ryan, K. M., Bui, M. D., Dugas, J. N., Zvonar, I., Tobin, J. M. 2021

    Abstract

    Drowning results in more than 360,000 deaths annually, making it the 3rd leading cause of unintentional injury death worldwide. Prior studies have examined airway interventions affecting patient outcomes in cardiac arrest, but less is known about drowning patients in arrest. This study evaluated the outcomes of drowning patients in the Cardiac Arrest Registry to Enhance Survival (CARES) who received advanced airway management.A retrospective analysis of the CARES database identified cases of drowning etiology between 2013 and 2018. Patients were stratified by airway intervention performed by EMS personnel. Demographics, sustained return of spontaneous circulation [ROSC], survival to hospital admission, survival to hospital discharge, and neurological outcomes were compared between airway groups using chi-squared tests and logistic regression.Among 2,388 drowning patients, 70.4% were male, 41.8% white, and 13.1% survived to hospital discharge. Patients that received supraglottic airways [SGA] had statistically significantly lower odds of survival to hospital admission compared to endotracheal tube [ETT] use (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI] 0.42-0.76) as well as lower odds of survival to discharge compared to bag valve mask [BVM] use (aOR = 0.40, 95% CI 0.19-0.86) when accounting for relative ROSC timing.In this national cohort of drowning patients in cardiac arrest, SGA use was associated with significantly lower odds of survival to hospital admission and discharge. However, survival to discharge with favorable neurological outcome did not differ significantly between airway management techniques. Further studies will need to examine if airway intervention order or time to intervention affects outcomes.

    View details for DOI 10.1016/j.resuscitation.2020.12.027

    View details for PubMedID 33482267

  • Toward an Electrical Analog of the Cardiovascular System in Hemorrhage. Cardiovascular engineering and technology Tobin, J. M. 2021

    Abstract

    Current quantitative descriptions of the cardiovascular system in hemorrhagic shock focus on pressure based metrics. This approach is often incomplete; overlooking the important role of tissue perfusion. Electrical analogs to the cardiovascular system may offer a more complete description of hemorrhage. Application of fundamental concepts in electrical circuit theory (i.e.; Kirchhoff's Voltage Law and Ohm's Law) to analogs of the cardiovascular system offers a more refined description of this complex process. This manuscript hopes to serve as a starting point for a more mathematically robust, and clinically relevant description of hemorrhagic shock.

    View details for DOI 10.1007/s13239-021-00545-8

    View details for PubMedID 34018154

  • Defining Combat-Relevant Endpoints for Ear1y Trauma Resuscitation Research in a Resource-Constrained Civilian Setting. Medical journal (Fort Sam Houston, Tex.) Mould-Millman, N. K., Mata, L., Schauer, S. G., Dixon, J., Keenan, S., Holcomb, J. B., Tobin, J. M., Moore, E., de Vries, S., Bedard, A., Bebarta, V. S., Ginde, A. A. 2021: 3-14

    Abstract

    Studies assessing early trauma resuscitation have used long-term endpoints, such as 28- or 30-day mortality or Glasgow Outcomes Scores at 6-months. These endpoints are convenient but may not accurately reflect the effect of early resuscitation. We sought expert opinion and consensus on endpoints and definitions of variables needed to conduct a Department of Defense- (DoD) funded study to epidemiologically assess combat-relevant mortality and morbidity due to timeliness of resuscitation among critically injured civilians internationally.We conducted an online modified Delphi process with an international panel of civilian and US military experts. In several iterative rounds, experts reviewed background information, appraised relevant scientific evidence, provided comments, and rendered a vote on each variable. A-priori, we set consensus at ≥80% concordant votes.Twenty panelists participated with a 100% response rate. Eight items were presented, with the following outputs for the epidemiologic study: Assess mortality within 7-days of injury; assess multi-organ failure using SOFA scores measured early (at day 3) and late (at day 7); assess traumatic brain injury mortality early (≤7-days) and late (28-days); hybrid (anatomic and physiologic) injury severity scoring is optimal; capture comorbidities per the US National Trauma Data Standard list with specific additions; assign resuscitative interventions to one of five standardized phases of trauma care; and, use a novel trauma death categorization system.A modified Delphi process yielded expert-ratified definitions and endpoints of variables necessary to conduct a combat-relevant epidemiologic study assessing outcomes due to early trauma resuscitation. Outputs may also benefit other groups conducting trauma resuscitation research.

    View details for PubMedID 34449854

  • Multidisciplinary prehospital critical care. The journal of trauma and acute care surgery Tobin, J. M., Reid, C., Burns, B. J. 2020; 89 (6): e188–e189

    View details for DOI 10.1097/TA.0000000000002858

    View details for PubMedID 33231953

  • Airway Management in Prolonged Field Care. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals Dye, C., Keenan, S., Carius, B. M., Loos, P. E., Remley, M. A., Mendes, B., Arnold, J. L., May, I., Powell, D., Tobin, J. M., Riesberg, J. C., Shackelford, S. A. 2020; 20 (3): 141-156

    Abstract

    This Role 1, prolonged field care (PFC) clinical practice guideline (CPG) is intended to be used after Tactical Combat Casualty Care (TCCC) Guidelines, when evacuation to higher level of care is not immediately possible. A provider must first and foremost be an expert in TCCC, the Department of Defense standard of care for first responders. The intent of this PFC CPG is to provide evidence and experience-based solutions to those who manage airways in an austere environment. An emphasis is placed on utilizing the tools and adjuncts most familiar to a Role 1 provider. The PFC capability of airway is addressed to reflect the reality of managing an airway in a Role 1 resource-constrained environment. A separate Joint Trauma System CPG will address mechanical ventilation. This PFC CPG also introduces an acronym to assist providers and their teams in preparing for advanced procedures, to include airway management.

    View details for PubMedID 32969020

  • Immuno-therapeutic Options for Inflammation in Trauma. The journal of trauma and acute care surgery Tobin, J. M., Gavitt, B. J., Nomellini, V., Dobson, G. P., Letson, H. L., Shackelford, S. A. 2020

    Abstract

    Surgical management of trauma in the last twenty years has evolved in parallel with the military's experience in the current conflicts. Therapies such as wide-spread tourniquet use, empiric administration of fresh frozen plasma, and airborne intensive care units had been viewed skeptically, but are now common practice. There is an opportunity to expand the envelope of care even further through similarly innovative approaches and varied avenues of research.As the molecular biology of trauma is elucidated, research methodologies must also be developed to capitalize on innovative approaches to resuscitation. Blood component therapy and control of bleeding remain as the fundamental concepts in trauma care. The inflammo-immune response to injury, however, plays an increasingly recognized role in recovery of organ function. Perhaps the inflammatory cascade of trauma can be manipulated to extend the treatment envelope of at risk trauma patients.In trauma, the additional challenge of delivering effective treatment, often required very early after injury, necessitates the development of treatments to be implemented on the front lines of trauma care that are cost effective, portable, and environmentally stable. Future conflicts may not offer ready access to high level surgical care, therefore resuscitative therapies will be needed for wounded service members as they are evacuated to the surgeon. Manipulation of the inflammatory response to trauma may offer a solution. As our understanding of the immune response continues to develop, the potential for improved outcomes for the wounded expands.A review of basic concepts in immunology is necessary to appreciate any potential impact of immuno-therapeutic approaches to trauma and inflammation. An overview of current options will focus on outcome benefits of available therapies and suggest possible areas for future investigation. Quantitative approaches will leverage basic science to identify high yield strategies to improve care of the injured combatant.Review LEVEL OF EVIDENCE: III.

    View details for DOI 10.1097/TA.0000000000002810

    View details for PubMedID 32467462

  • Comparison of trauma resuscitation practices by critical care anesthesiologists and non-critical care anesthesiologists. Journal of clinical anesthesia Bardes, J. M., Biswas, S., Strumwasser, A. M., Schellenberg, M., Inaba, K., Demetriades, D., Tobin, J. M. 2020; 65: 109890

    View details for DOI 10.1016/j.jclinane.2020.109890

    View details for PubMedID 32460105

  • Outcome of Conventional Bystander Cardiopulmonary Resuscitation in Cardiac Arrest Following Drowning. Prehospital and disaster medicine Tobin, J. M., Ramos, W. D., Greenshields, J., Dickinson, S., Rossano, J. W., Wernicki, P. G., Markenson, D., Vellano, K., McNally, B. 2020; 35 (2): 141-147

    Abstract

    The concept of compressions only cardiopulmonary resuscitation (CO-CPR) evolved from a perception that lay rescuers may be less likely to perform mouth-to-mouth ventilations during an emergency. This study hopes to describe the efficacy of bystander compressions and ventilations cardiopulmonary resuscitation (CV-CPR) in cardiac arrest following drowning.The aim of this investigation is to test the hypothesis that bystander cardiopulmonary resuscitation (CPR) utilizing compressions and ventilations results in improved survival for cases of cardiac arrest following drowning compared to CPR involving compressions only.The Cardiac Arrest Registry for Enhanced Survival (CARES) was queried for patients who suffered cardiac arrest following drowning from January 1, 2013 through December 31, 2017, and in whom data were available on type of bystander CPR delivered (ie, CV-CPR CO-CPR). The primary outcome of interest was neurologically favorable survival, as defined by cerebral performance category (CPC).Neurologically favorable survival was statistically significantly associated with CV-CPR in pediatric patients aged five to 15 years (aOR = 2.68; 95% CI, 1.10-6.77; P = .03), as well as all age group survival to hospital discharge (aOR = 1.54; 95% CI, 1.01-2.36; P = .046). There was a trend with CV-CPR toward neurologically favorable survival in all age groups (aOR = 1.35; 95% CI, 0.86-2.10; P = .19) and all age group survival to hospital admission (aOR = 1.29; 95% CI, 0.91-1.84; P = .157).In cases of cardiac arrest following drowning, bystander CV-CPR was statistically significantly associated with neurologically favorable survival in children aged five to 15 years and survival to hospital discharge.

    View details for DOI 10.1017/S1049023X20000060

    View details for PubMedID 31973778

  • Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics. Resuscitation Griffis, H., Wu, L., Naim, M. Y., Bradley, R., Tobin, J., McNally, B., Vellano, K., Quan, L., Markenson, D., Rossano, J. W. 2020; 146: 126-131

    Abstract

    Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA.Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes.Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics.Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.

    View details for DOI 10.1016/j.resuscitation.2019.09.038

    View details for PubMedID 31785372

  • Extracorporeal membrane oxygenation in trauma: A single institution experience and review of the literature. The International journal of artificial organs Strumwasser, A., Tobin, J. M., Henry, R., Guidry, C., Park, C., Inaba, K., Demetriades, D. 2018; 41 (12): 845-853

    Abstract

    Limited options exist for cardiovascular support of the trauma patient in extremis. This patient population offers challenges that are often considered insurmountable. This article identifies a heterogeneous group of trauma patients in extremis who may benefit from extracorporeal membrane oxygenation.Data were sourced from the medical records of all patients placed on extracorporeal membrane oxygenation following trauma at a Level I Trauma Center between 1 December 2016 and 1 December 2017.All patients were male (N = 7), mostly with blunt injuries (n = 5), with an average age of 41 years and with an average Injury Severity Scores of 33 (median = 34). Two out of seven patients survived (28.5%). Survivors tended to have a longer duration on extracorporeal membrane oxygenation (13.5 vs 3.8 days), had extracorporeal membrane oxygenation initiated later (15 vs 7.8 days), and had suffered a blunt injury. Two patients were initiated on veno-arterial extracorporeal membrane oxygenation (both non-survivors) and five were initiated on veno-venous extracorporeal membrane oxygenation (two survivors, three non-survivors). Five patients were heparinized immediately (one survivor, four non-survivors), and two patients were heparinized after clotting was noted in the circuit (one survivor, one non-survivor). Three of the seven (42.8%) patients suffered cardiac arrest either prior to, or during, the initiation of extracorporeal membrane oxygenation (all non-survivors).Extracorporeal membrane oxygenation use in the trauma patient in extremis is not standard; however, this article demonstrates that extracorporeal membrane oxygenation is feasible in a complex, heterogeneous patient population when treated at designated centers.

    View details for DOI 10.1177/0391398818794111

    View details for PubMedID 30117348

  • Airway Management for Trauma Patients. Military medicine Walrath, B. D., Harper, S., Barnard, E., Tobin, J. M., Drew, B., Cunningham, C., Kharod, C., Spradling, J., Stone, C., Martin, M. 2018; 183 (suppl_2): 29-31

    Abstract

    Trauma airway management is a critical skill for medical providers supporting combat casualties since it is an integral component of damage control resuscitation and surgery. This clinical practice guideline presents methods for optimizing the airway management of patients with traumatic injury in the operational medical treatment facility environment. The guidelines represent the knowledge and experience of 10 co-authors from 3 allied countries representing Emergency Medicine, Surgery and Anesthesia.

    View details for DOI 10.1093/milmed/usy124

    View details for PubMedID 30189067

  • Dry drowning: A distinction without a difference. Resuscitation Tobin, J. M., Rossano, J. W., Wernicki, P. G., Fielding, R., Quan, L., Markenson, D. 2017; 118: e5-e6
  • Transesophageal echocardiography in the evaluation of the trauma patient: A trauma resuscitation transesophageal echocardiography exam. Journal of critical care Leichtle, S. W., Singleton, A., Singh, M., Griffee, M. J., Tobin, J. M. 2017; 40: 202-206

    Abstract

    The point-of-care ultrasound exam has become an essential tool for hemodynamic monitoring and resuscitation in the trauma bay as well as the intensive care unit. Transthoracic ultrasound provides a dynamic assessment of cardiac function, volume status, and fluid responsiveness that offers potential advantage over traditional methods of hemodynamic monitoring. More recently, a focused transthoracic echocardiography exam was described to improve immediate resuscitation of severely injured patients in the trauma bay. Transesophageal echocardiography (TEE) for trauma could expand upon the role of focused echocardiography. TEE offers improved visualization of cardiac anatomy and physiology, improved diagnostic accuracy, and real-time assessment of intraoperative resuscitation progress, particularly in the operating room. This review discusses the fundamental principles of echocardiography as well as different ultrasound modes with their respective strengths and limitations. It reviews the current literature on the use of TEE in trauma, and suggests views for a trauma resuscitation transesophageal echocardiography exam (TREE), including sample images and videos.

    View details for DOI 10.1016/j.jcrc.2017.04.007

    View details for PubMedID 28433951

  • Prehospital Resuscitation. International anesthesiology clinics Tobin, J. M., Lockey, D. J. 2017; 55 (3): 36-49

    View details for DOI 10.1097/AIA.0000000000000145

    View details for PubMedID 28598879

  • Anesthesiologist as Resuscitation Consultant. International anesthesiology clinics Tobin, J. M. 2017; 55 (3): 1-3

    View details for DOI 10.1097/AIA.0000000000000152

    View details for PubMedID 28598876

  • Bystander CPR is associated with improved neurologically favourable survival in cardiac arrest following drowning. Resuscitation Tobin, J. M., Ramos, W. D., Pu, Y., Wernicki, P. G., Quan, L., Rossano, J. W. 2017; 115: 39-43

    Abstract

    Cardiac arrest associated with drowning is a major public health concern with limited research available on outcome. This investigation aims to define the population at risk, and identify factors associated with neurologically favourable survival.The Cardiac Arrest Registry for Enhanced Survival (CARES) database was queried for patients who had suffered cardiac arrest following drowning between January 1, 2013 and December 31, 2015. The primary outcomes of interest were for favourable or unfavourable neurological outcome at hospital discharge, as defined by Cerebral Performance Category (CPC).A total of 919 drowning patients were identified. Neurological outcome data was available in 908 patients. Neurologically favourable survival was significantly associated with bystander CPR (Odds Ratio (OR)=2.94; 95% Confidence Interval (CI) 1.86-4.64; p<0.001), witnessed drowning (OR=2.6; 95% CI 1.69-4.01; p<0.001) and younger age (OR=0.97, 95% CI 0.96-0.98; p<0.001). Public location of drowning (OR=1.17; 95% CI 0.77-1.79; p=0.47), male gender (OR=0.9, 95% CI 0.57-1.43; p=0.66), and shockable rhythm (OR=1.54; 95% CI 0.76-3.12; p=0.23), were not associated with favourable neurological survival. AED application prior to EMS was associated with a decreased likelihood of favourable neurological outcome (OR=0.38; 95% CI 0.28-0.66; p<0.001). In multivariate analysis, bystander CPR (adjusted OR 3.02, 95% CI 1.85-4.92, p<0.001), witnessed drowning (adjusted OR 3.27, 95% CI 2.0-5.36, p<0.001) and younger age (adjusted OR 0.97, 95% CI 0.96-0.98, p<0.001) remained associated with neurologically favourable survival.Neurologically favourable survival after drowning remains low but is improved by bystander CPR. Shockable rhythms were uncommon and not associated with improved outcomes.

    View details for DOI 10.1016/j.resuscitation.2017.04.004

    View details for PubMedID 28385639

  • The Ryder Cognitive Aid Checklist for Trauma Anesthesia. Anesthesia and analgesia Behrens, V., Dudaryk, R., Nedeff, N., Tobin, J. M., Varon, A. J. 2016; 122 (5): 1484-7

    Abstract

    Despite mixed results regarding the clinical utility of checklists, the anesthesia community is increasingly interested in advancing research around this important topic. Although several checklists have been developed to address routine perioperative care, few checklists in the anesthesia literature specifically target the management of trauma patients. We adapted a recently published "trauma and emergency checklist" for the initial phase of resuscitation and anesthesia of critically ill trauma patients into an applicable perioperative cognitive aid in the form of a pictogram that can be downloaded by the medical community. The Ryder Cognitive Aid Checklist for Trauma Anesthesia is a letter-sized, full-color document consisting of 2 pages and 5 sections. This cognitive aid describes the essential steps to be performed: before patient arrival to the hospital, on patient arrival to the hospital, during the initial assessment and management, during the resuscitation phase, and for postoperative care. A brief online survey is also presented to obtain feedback for improvement of this tool. The variability in utility of cognitive aids may be because of the specific clinical task being performed, the skill level of the individuals using the cognitive aid, overall quality of the cognitive aid, or organizational challenges. Once optimized, future research should be focused at ensuring successful implementation and customization of this tool.

    View details for DOI 10.1213/ANE.0000000000001186

    View details for PubMedID 27101496

  • Resuscitation During Critical Care Transportation in Afghanistan. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals Tobin, J. M., Nordmann, G. R., Kuncir, E. J. 2015; 15 (3): 72-5

    Abstract

    These data describe the critical care procedures performed on, and the resuscitation markers of, critically wounded personnel in Afghanistan following point of injury (POI) transports and intratheater transports. Providing this information may help inform discussion on the design of critical care transportation platforms for future conflicts.The Department of Defense Trauma Registry (DoDTR) was queried for descriptive data on combat casualties with Injury Severity Score (ISS) greater than 15 who were transported in Operation Enduring Freedom (OEF) from 1 January 2010 to 31 December 2010. Both POI transportation events and interfacility transportation events were reviewed. Base deficit (BD) was evaluated as a maker of resuscitation, and international normalized ratio (INR) was evaluated as a measure of coagulopathy.There were 1198 transportation events that occurred during the study period--634 (53%) transports from the POI and 564 (47%) intratheater transports. Critical care interventions were performed during 147 (12.3%) transportation events, including intubation, cricothyrotomy, double-lumen endotracheal tube placement, needle or tube thoracostomy, central venous access placement, and cardiopulmonary resuscitation. The mean BD on arrival in the emergency department was -5.4 mEq/L for POI transports and 0.68 mEq/L intratheater transports (ρ<.001). The mean INR on arrival in the emergency department was 1.48 for POI transports and 1.21 for intratheater transports (ρ<.001).Critical care interventions were needed frequently during evacuation of severely injured personnel. Furthermore, many troops arrived acidotic and coagulopathic following initial transport from POI. Together, these data suggest that a platform capable of damage control resuscitation and critical care interventions may be warranted on longer transports of more critically injured patients.

    View details for PubMedID 26360357

  • Factor concentrates in trauma. Current opinion in anaesthesiology Tobin, J. M., Tanaka, K. A., Smith, C. E. 2015; 28 (2): 217-26

    Abstract

    Recent advances in the understanding of transfusion practices during hemorrhagic shock in trauma have led to early administration of thawed plasma in increased ratios to packed red blood cells and have improved survival in the most severely injured patients. As an appreciation for the sequelae of massive transfusion continues to mature, it is becoming apparent that a more targeted approach to coagulation deficiencies may offer an advantage.Factor concentrate therapy offers the advantage of smaller volumes of resuscitative fluids directed at specific phases of coagulation identified by alternative laboratory assays (e.g., viscoelastic testing). Case reports, animal studies, and retrospective reviews offer encouraging data on the ability of factor concentrates to reverse coagulopathy and reduce blood product usage.The use of factor concentrates to target specific phases of coagulation may offer benefit over blood product ratio-driven transfusion. The outcome benefit of factor concentrates, however, has not yet been demonstrated in well powered prospective trials.

    View details for DOI 10.1097/ACO.0000000000000167

    View details for PubMedID 25674987

  • Hypotensive resuscitation in a head-injured multi-trauma patient. Journal of critical care Tobin, J. M., Dutton, R. P., Pittet, J. F., Sharma, D. 2014; 29 (2): 313.e1-5

    Abstract

    The concept of permissive hypotension is a controversial topic in trauma care. While driving blood pressure to "normal" levels with large volume crystalloid infusions is not appropriate, definitive data on the target blood pressure for hypotensive resuscitation are lacking. Indeed, the concept of systolic blood pressure as a marker for resuscitation is arguable. In this case presentation, a panel of experts in trauma resuscitation discusses the merits and limitations of hypotensive resuscitation in the context of a patient who has sustained multiple injuries, including a head injury. The controversies highlighted herein call attention to the role of the intensivist in managing a continuing resuscitation while coordinating the care of other physicians whose therapies can run at cross-purposes to one another. The challenges of the practice of critical care in the 21st century are no more apparent than in the care of a complex trauma patient.

    View details for DOI 10.1016/j.jcrc.2013.11.017

    View details for PubMedID 24388660

  • Developing a trauma curriculum for anesthesiology residents and fellows. Current opinion in anaesthesiology Tobin, J. M. 2014; 27 (2): 240-5

    Abstract

    The board certification process for qualification by the American Board of Anesthesiology is undergoing significant review. A basic sciences examination has been added to the process and the traditional oral examination is evolving into a combined oral interview and practical skills assessment. These recent developments, as well as the growing body of evidence regarding the resuscitation of trauma patients, call for a revision in the curriculum beyond the documentation of participation in the anesthetics of 20 trauma patients.The implications of the 80-h work week are beginning to be appreciated. The development of a new trauma curriculum must take this significant change in residency training into account while incorporating modern educational theory (e.g. simulation) and new data on the resuscitation of trauma patients.Currently, the curriculum for trauma anesthesia requires only that residents participate in the anesthetics of 20 trauma patients. There is no plan for, and little literature regarding, a more extensive educational program. This offers a unique opportunity to innovate a novel curriculum in the anesthesiology residency. The American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness has designed a curriculum that can serve as a template for this important step forward in anesthesiology education.

    View details for DOI 10.1097/ACO.0000000000000020

    View details for PubMedID 24535188

  • It is time to reassess critical care evacuation. The journal of trauma and acute care surgery Tobin, J. M., Nelson, T. J., Moore, J. D. 2014; 76 (1): 250

    View details for DOI 10.1097/TA.0b013e3182aa3d19

    View details for PubMedID 24368392

  • A checklist for trauma and emergency anesthesia. Anesthesia and analgesia Tobin, J. M., Grabinsky, A., McCunn, M., Pittet, J. F., Smith, C. E., Murray, M. J., Varon, A. J. 2013; 117 (5): 1178-84

    View details for DOI 10.1213/ANE.0b013e3182a44d3e

    View details for PubMedID 24108256

  • Emergency management of the trauma airway. Journal of clinical anesthesia Tobin, J. M., Varon, A. J. 2013; 25 (7): 605-7

    View details for DOI 10.1016/j.jclinane.2013.06.002

    View details for PubMedID 23994703

  • Review article: update in trauma anesthesiology: perioperative resuscitation management. Anesthesia and analgesia Tobin, J. M., Varon, A. J. 2012; 115 (6): 1326-33

    Abstract

    The management of trauma patients has matured significantly since a systematic approach to trauma care was introduced nearly a half century ago. The resuscitation continuum emphasizes the effect that initial therapy has on the outcome of the trauma patient. The initiation of this continuum begins with prompt field medical care and efficient transportation to designated trauma centers, where lifesaving procedures are immediately undertaken. Resuscitation with packed red blood cells and plasma, in parallel with surgical or interventional radiologic source control of bleeding, are the cornerstones of trauma management. Adjunctive pharmacologic therapy can assist with resuscitation. Tranexamic acid is used in Europe with good results, but the drug is slowly being added to the pharmacy formulary of trauma centers in United States. Recombinant factor VIIa can correct abnormal coagulation values, but its outcome benefit is less clear. Vasopressin shows promise in animal studies and case reports, but has not been subjected to a large clinical trial. The concept of "early goal-directed therapy" used in sepsis may be applicable in trauma as well. An early, appropriately aggressive resuscitation with blood products, as well as adjunctive pharmacologic therapy, may attenuate the systemic inflammatory response of trauma. Future investigations will need to determine whether this approach offers a similar survival benefit.

    View details for DOI 10.1213/ANE.0b013e3182639f20

    View details for PubMedID 22763906

  • Usage and efficacy of airway adjuncts in an emergency intubation kit EMERGENCY MEDICINE AUSTRALASIA Tobin, J. M. 2011; 23 (4): 514–15
  • Tactical Evacuation: Extending Critical Care on Rotary Wing Platforms to Forward Surgical Facilities MILITARY MEDICINE Tobin, J. M., Via, D. K., Carter, T. 2011; 176 (1): 4–6

    View details for DOI 10.7205/MILMED-D-10-00139

    View details for Web of Science ID 000286015800002

    View details for PubMedID 21305952

  • "Damage control resuscitation for the Special Forces medic: simplifying and improving prolonged trauma care"(JSOM 2009, Vol 9, Eds 3-4) by Dr. Risk and Mike Hetzler, 18D. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals Tobin, J. M. 2010; 10 (1): 63

    View details for PubMedID 20306418

  • A Hemodynamic Profile for Consciousness During Cardiopulmonary Resuscitation ANESTHESIA AND ANALGESIA Tobin, J. M., Mihm, F. G. 2009; 109 (5): 1598-1599

    Abstract

    We report the quantification of a hemodynamic profile sufficient to support consciousness during cardiopulmonary resuscitation. A 62-yr-old man experienced cardiac arrest while being evaluated for heart failure after heart transplantation. During the emergency, hemodynamic data were obtained from bedside monitors and reviewed at regular intervals. His mean arterial blood pressure and heart rate were correlated with consciousness during cardiopulmonary resuscitation. A mean arterial blood pressure of 50 mm Hg with a heart rate of 100 bpm supported consciousness during cardiac arrest. This case helps to validate the recent emphasis on hard, fast, basic life support.

    View details for DOI 10.1213/ANE.0b013e3181b89432

    View details for Web of Science ID 000271032500040

    View details for PubMedID 19843796

  • Trauma anesthesia plan for non-permissive environments. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals Tobin, J. M. 2009; 9 (4): 32-5

    Abstract

    The current war has, like past conflicts, presented the medical community with opportunities to innovate novel approaches to old problems. Although trauma anesthesia is provided adequately in the majority of cases, a standardized approach for treating these complex and critically ill patients is lacking. While this technique was developed for anesthesia in non-permissive environments, the principles suggested here could serve as a template for trauma anesthesia in other environments as well. The algorithm is designed as a standardized protocol in an effort to simplify the approach to these complex patients who often present in a dynamic environment. A list of required equipment is included to serve as a guide for preparation prior to employment of the algorithm.

    View details for PubMedID 20112646