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Paillusson W, Sesmun R, Arvieux C, Balandraud P, Martinod E, Kuczma P, Tresallet C. Surgical management of penetrating neck injuries: An update. Part 1 - pre-hospital management. J Visc Surg 2024:S1878-7886(24)00105-X. [PMID: 39122622 DOI: 10.1016/j.jviscsurg.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Affiliation(s)
- Willem Paillusson
- Digestive, Bariatric and Endocrine Surgery Department, Avicenne University Hospital, AP-HP, 93000 Bobigny, France; UFR de santé Paris XII, Paris-Est Créteil University, 94000 Créteil, France
| | - Rajvansh Sesmun
- Digestive, Bariatric and Endocrine Surgery Department, Avicenne University Hospital, AP-HP, 93000 Bobigny, France; UFR de médecine et de biologie humaine, Sorbonne Paris Nord University, 93000 Bobigny, France
| | - Catherine Arvieux
- Digestive Surgery and Emergency Department, Grenoble-Alpes University Hospital, 38043 Grenoble, France
| | - Paul Balandraud
- Department of Oncologic and General Surgery, Sainte-Anne Military Hospital, 83000 Toulon, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Avicenne University Hospital, AP-HP, 93000 Bobigny, France; UFR de médecine et de biologie humaine, Sorbonne Paris Nord University, 93000 Bobigny, France
| | - Paulina Kuczma
- Digestive, Bariatric and Endocrine Surgery Department, Avicenne University Hospital, AP-HP, 93000 Bobigny, France; UFR de médecine et de biologie humaine, Sorbonne Paris Nord University, 93000 Bobigny, France
| | - Christophe Tresallet
- Digestive, Bariatric and Endocrine Surgery Department, Avicenne University Hospital, AP-HP, 93000 Bobigny, France; UFR de médecine et de biologie humaine, Sorbonne Paris Nord University, 93000 Bobigny, France.
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Leeper WR, James N. Trauma Bay Evaluation and Resuscitative Decision-Making. Surg Clin North Am 2024; 104:293-309. [PMID: 38453303 DOI: 10.1016/j.suc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
The reader of this article will now have the ability to reflect on all aspects of high-quality trauma bay care, from resuscitation to diagnosis and leadership to debriefing. Although there is no replacement for experience, both clinically and in a simulation environment, trauma clinicians are encouraged to make use of this article both as a primer at the beginning of a trauma rotation and a reference text to revisit after difficult cases in the trauma bay. Also, periods of reflection seem appropriate in the busy but, of course, rewarding career in trauma care.
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Affiliation(s)
- William Robert Leeper
- Department of Surgery, Western University, Victoria Campus, London Health Sciences Center, Room E2-215, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; Trauma Program at London Health Sciences Center, Division of Critical Care, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Nicholas James
- London Health Sciences Center, Victoria Campus, Room E2-214, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada; Trauma Program at London Health Sciences Center, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Vrancken SM, de Vroome M, van Vledder MG, Halm JA, Van Lieshout EMM, Borger van der Burg BLS, Hoencamp R, Verhofstad MHJ, van Waes OJF. Non-compressible truncal and junctional hemorrhage: A retrospective analysis quantifying potential indications for advanced bleeding control in Dutch trauma centers. Injury 2024; 55:111183. [PMID: 37981519 DOI: 10.1016/j.injury.2023.111183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/06/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Truncal and junctional hemorrhage is the leading cause of potentially preventable deaths in trauma patients. To reduce this mortality, the application of advanced bleeding control techniques, such as resuscitative endovascular balloon occlusion of the aorta (REBOA), junctional tourniquets, Foley catheters, or hemostatic agents should be optimized. This study aimed to identify trauma patients with non-compressible truncal and junctional hemorrhage (NCTJH) who might benefit from advanced bleeding control techniques during initial trauma care. We hypothesized that there is a substantial cohort of Dutch trauma patients that can possibly benefit from advanced bleeding control techniques. METHODS Adult trauma patients with an Abbreviated Injury Scale ≥3 in the torso, neck, axilla, or groin region, who were presented between January 1st, 2014 and December 31st, 2018 to two Dutch level-1 trauma centers, were identified from the Dutch Trauma Registry. Potential indications for advanced bleeding control in patients with NCTJH were assessed by an expert panel of three trauma surgeons based on injury characteristics, vital signs, response to resuscitation, and received treatment. RESULTS In total, 1719 patients were identified of whom 249 (14.5 %) suffered from NCTJH. In 153 patients (60.6 %), hemorrhagic shock could have been mitigated or prevented with advanced bleeding control techniques. This group was younger and more heavily injured: median age of 40 versus 48 years and median ISS 33 versus 22 as compared to the entire cohort. The mortality rate in these patients was 31.8 %. On average, each of the included level-1 trauma centers treated an NCTJH patient every 24 days in whom a form of advanced bleeding control could have been beneficial. CONCLUSIONS More than half of included Dutch trauma patients with NCTJH may benefit from in-hospital application of advanced bleeding control techniques, such as REBOA, during initial trauma care. Widespread implementation of these techniques in the Dutch trauma system may contribute to reduction of mortality and morbidity from non-compressible truncal and junctional hemorrhage.
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Affiliation(s)
- Suzanne M Vrancken
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Trauma Research Unit, Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands.
| | - Matthijs de Vroome
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mark G van Vledder
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jens A Halm
- Trauma Research Unit, Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Oscar J F van Waes
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands
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Vrancken SM, Agelink N, van Waes OJ, Borger van der Burg BL, van Dongen TT, Verhofstad MH, Hoencamp R. The effectiveness of Foley catheter balloon tamponade versus expanding sponges and hemostatic granules for catastrophic penetrating groin hemorrhage with small skin defect: A comparative study in a live tissue porcine model with evaluation of a concise training program. J Trauma Acute Care Surg 2023; 94:599-607. [PMID: 36730102 PMCID: PMC10045958 DOI: 10.1097/ta.0000000000003836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/16/2022] [Accepted: 11/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prompt bleeding control in the prehospital phase is essential to improve survival from catastrophic junctional hemorrhage. This study aimed to compare the effectiveness and practicality of Foley catheter balloon tamponade (FCBT), Celox-A, and XSTAT for the treatment of catastrophic hemorrhage from penetrating groin injuries with a small skin defect in a live-tissue porcine model. In addition, this study aimed to determine whether a training program could train military personnel in application of these advanced bleeding control adjuncts. METHODS A standardized wound was created in 18 groins from 9 anesthetized swine. Eighteen military medics participated in the training program and performed a bleeding control procedure after randomization over the swine and test products and after transection of the femoral neurovascular bundle. Primary endpoints were bleeding control, time to bleeding control, rebleeding, blood loss, medic performance, and user product rating. RESULTS No significant differences were found in vital signs and laboratory values between the groups. In the Celox-A group, 3/6 groins achieved hemorrhage control. This was 6/6 in the XSTAT and FCBT groups. XSTAT scored best on application time, time to obtain hemorrhage control, hemorrhage control score, and practicality. No significant differences were found between groups for rebleeding, amount of blood loss, and medic performance. Military medics had a significant higher preference for XSTAT over Celox-A. This was not significant for FCBT. CONCLUSION All tested products proved effective in obtaining hemorrhage control. XSTAT has the highest effectivity and shortest application time for the treatment of catastrophic bleeding from nonpackable, penetrating junctional groin injuries with a small skin defect, compared with Celox-A and FCBT. XSTAT scored best on practicality. This study shows that our training curriculum can be used to train military medics with limited prior experience in the use of advanced bleeding control techniques for penetrating junctional groin injuries with small skin defect.
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Papan AM, Husseinzade M, Heydari K, Hamidi H. Occlusion of femoral artery using Foley catheter: A REBOA inspired tale to save a life. Clin Case Rep 2023; 11:e7215. [PMID: 37077719 PMCID: PMC10106927 DOI: 10.1002/ccr3.7215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 12/26/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
In this case report, we emphasized the need to control bleeding in emergency departments by any measure possible, as it is the first step toward successful resuscitation for saving the lives of patients with active bleeding.
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Affiliation(s)
- Amir Mohammad Papan
- Department of Emergency MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Mofid Husseinzade
- Department of Emergency MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Kamran Heydari
- Department of Emergency MedicineShahid Beheshti UniversityTehranIran
| | - Hossein Hamidi
- Department of Emergency MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
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Kong V, Ko J, Cheung C, Lee B, Leow P, Thirayan V, Bruce J, Laing G, Khashram M, Clarke D. Foley Catheter Balloon Tamponade for Actively Bleeding Wounds Following Penetrating Neck Injury is an Effective Technique for Controlling Non-Compressible Junctional External Haemorrhage. World J Surg 2022; 46:1067-1075. [PMID: 35211783 DOI: 10.1007/s00268-022-06474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The foley catheter balloon tamponade (FCBT) has been widely employed in the management of trauma. This study reviews our cumulative experience with the use of FCBT in the management of patients presenting with a penetrating neck injury (PNI). METHODS A retrospective study was conducted at a major trauma centre in South Africa over a 9-year period from January 2012 to December 2020. All patients who presented with a PNI who had FCBT were included. RESULTS A total of 1581 patients with a PNI were managed by our trauma centre, and 44 (3%) patients had an FCBT. Of the 44 cases of FCBT, stab wounds accounted for 93% (41/44) and the remaining 7% were for gunshot wounds. Seventy-five per cent of all FCBT (33/44) were inserted at a rural hospital prior to transfer to our trauma centre; the remaining 25% (11/44) were inserted in our resuscitation room. The success rate of FCBT was 80% (35/44), allowing further CT with angiography (CTA) to be performed. CTA findings were: 10/35 (29%) positive, 18/35 (51%) negative, and 7/35 (20%) equivocal. Fifteen patients required additional intervention (open surgery or endovascular intervention). The overall morbidity was 14% (6/44). Eighteen per cent required intensive care unit admission. The median length of stay was 1 day. The overall mortality rate was 11% (5/44). CONCLUSION FCBT is a simple and effective technique as an adjunct in the management of major haemorrhage from a PNI. In highly selective patients, it may also be used as definitive management.
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Affiliation(s)
- Victor Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa. .,Trauma Service, Department of Surgery, Auckland City Hospital, Grafton, Auckland, New Zealand.
| | - Jonathan Ko
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cynthia Cheung
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Bogo Lee
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Priscilla Leow
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Varun Thirayan
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - John Bruce
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Grant Laing
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Damian Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.,Department of Surgery, University of KwaZulu Natal, Durban, South Africa
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Beysard N, Pasquier M, Zingg T, Carron PN, Darioli V. The use of Foley catheter tamponade for bleeding control in penetrating injuries. Scand J Trauma Resusc Emerg Med 2021; 29:165. [PMID: 34863261 PMCID: PMC8642887 DOI: 10.1186/s13049-021-00975-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Nicolas Beysard
- Department of Emergency Medicine, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Tobias Zingg
- Department of Surgery, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Vincent Darioli
- Department of Emergency Medicine, Lausanne University Hospital, 1011, Lausanne, Switzerland.
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