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Hagiwara M, Iwata Y, Takahashi H, Imai K, Yokoo H, Ishitoya S, Ogata M, Matsuno N, Sumi Y, Furukawa H. Severe liver injury with traumatic cardiac arrest successfully treated by damage control surgery and transcatheter arterial embolization in the hybrid operating room: a case report. Surg Case Rep 2021; 7:234. [PMID: 34718909 PMCID: PMC8556852 DOI: 10.1186/s40792-021-01317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The damage control approach is known to reduce the mortality rate in severely injured patients and has now become a common practice. Transcatheter arterial embolization (TAE) has been shown to be useful with combining with damage control laparotomy in identifying and controlling active arterial hemorrhage. Hybrid operating room (OR) allows both damaged control surgery and TAE in the same location in minimal time. We report a case of a patient with three cardiac arrests who was saved by early intervention using damage control surgery (DCS) with interventional radiology (IVR) in the hybrid OR. Case presentation A 46-year-old woman was injured in a collision with a tree while snowboarding. She was eventually transported to hybrid operating room in our hospital with the diagnosis of significant liver laceration and hemorrhagic shock. Damage control surgery was performed with perihepatic packing (PHP) and TAE was conducted to stop active bleeding from right hepatic artery. She experienced 3 times of cardiopulmonary arrest, which was successfully resuscitated on each occasion. Although she had total of 3 times of laparotomy but tolerated well. She was discharged on day 82 of hospitalization and showed no neurological sequelae. Conclusion Saving the life of a patient with severe trauma requires a multidisciplinary approach with cooperation and early information sharing among trauma team members. Sharing treatment strategy with the trauma team and early intervention using DCS with IVR in the hybrid operating room could save the patient’s life.
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Affiliation(s)
- Masahiro Hagiwara
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan.
| | - Yoshihiro Iwata
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Hiroyuki Takahashi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Koji Imai
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Hideki Yokoo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Shunta Ishitoya
- Department of Radiology, Asahikawa Medical University, Asahikawa, Japan
| | - Miki Ogata
- Department of Radiology, Asahikawa Medical University, Asahikawa, Japan
| | - Naoto Matsuno
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
| | - Yasuo Sumi
- Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Furukawa
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan
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Khoo CY, Liew TYS, Mathur S. Systematic review of the efficacy of a hybrid operating theatre in the management of severe trauma. World J Emerg Surg 2021; 16:43. [PMID: 34454553 PMCID: PMC8403370 DOI: 10.1186/s13017-021-00390-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hybrid operating theatres (OT) allow for simultaneous interventional radiology and operative procedures, serving as a one-stop facility for the treatment of severely injured patients. Several countries have adopted the use of the hybrid OT however their clinical impact in improving efficiency and quality of care remains unclear. This study systematically reviews the clinical impact of the hybrid OT for treatment of the severely injured. Methods A literature review of the PubMed, Embase and Cochrane databases was performed to identify all published articles in English, from 1st January 2000 to 31st December 2020, reporting on the impact of a hybrid OT for severe trauma. Articles were also reviewed for references of interest. Results Five studies reporting the clinical impact of the hybrid OT, in a total of 951 patients, were shortlisted. All were cohort studies that compared patient outcomes in the hybrid OT versus a conventional group. Out of 3 studies that assessed timeliness to intervention, one reported shorter time associated with the hybrid OT, while the other two reported no difference. Mortality outcomes were reported in 4 studies and showed no significant difference associated with treatment in the hybrid OT. Two studies revealed shorter total procedure times associated with the hybrid OT. Two out of 3 studies that evaluated blood transfusion requirements reported decreased transfusion rates in the hybrid OT group. Only 1 study examined complication rates and demonstrated morbidity benefits associated with the hybrid OT. Conclusion Establishment of a hybrid OT requires a significant capital investment as well as a highly functioning multi-disciplinary team. The cost–benefit ratio remains unclear. Future studies, preferably in the form of clinical trials, are required to evaluate its usefulness in improving timeliness to definitive haemorrhage control and outcomes in severe trauma.
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Affiliation(s)
- Chun Yuet Khoo
- Department of General Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore.
| | - Terence Yi Song Liew
- Department of General Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Sachin Mathur
- Department of General Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
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Sandhu J, Abrahams R, Miller Z, Bhatia S, Zakrison TL, Mohan P. Pelvic Trauma: factors predicting arterial hemorrhage and the role of Angiography and preperitoneal pelvic packing. Eur Radiol 2020; 30:6376-6383. [PMID: 32518985 DOI: 10.1007/s00330-020-06965-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES (1) To identify the factors predicting arterial extravasation in pelvic trauma and (2) to assess the efficacy of preperitoneal pelvic packing (PPP) in controlling arterial hemorrhage. METHODS Institutional review board approved the retrospective study of 139 consecutive pelvic trauma patients who underwent angiographic intervention with or without prior PPP between January 2011 and December 2016. Patient demographics and presenting characteristics were recorded. Both groups of patients were combined for analysis of predictors for arterial extravasation using univariate logistic regression followed by multivariate logistic regression. Significance level was defined as p < 0.05. RESULTS Forty-nine out of 139 patients had PPP prior to pelvic angiogram. Embolization was performed in 85 (61.2%) patients and the technical and clinical success rate was 100%. Sixty-nine (49.7%) patients had unstable Young-Burgess (Y&B) type fractures, of which 58% had arterial hemorrhage compared with 38.6% of those with stable Y&B fractures (p = 0.02). Of the patients who had PPP prior to angiogram, 28(57.1%) continued to have arterial extravasation on subsequent angiography. Unstable Y&B type fractures are independent predictors of arterial hemorrhage (OR 2.3, 95%CI 1.1 to 4.7, p = 0.02). CONCLUSION Unstable Y&B type pelvic fractures are predictors of arterial extravasation. PPP alone is not effective for arterial hemorrhage control in pelvic trauma. Angiographic intervention remains a minimally invasive and definitive treatment of arterial hemorrhage from pelvic trauma. KEY POINTS • Unstable Young-Burgess pelvic fractures are predictors of arterial hemorrhage in pelvic trauma. • Pelvic angiography and embolization should precede PPP wherever feasible.
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Affiliation(s)
- Jagteshwar Sandhu
- University of Miami Miller School of Medicine, Miami, FL, USA. .,University of Miami Hospitals and Clinics, 1475 NW 12th Ave. Suite 1066-V, Miami, FL, 33136, USA.
| | - Robert Abrahams
- Diagnostic and Interventional Radiology, Haywood Medical Imaging, Clyde, NC, USA
| | - Zoe Miller
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shivank Bhatia
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tanya L Zakrison
- Department of Surgery, Jackson Memorial Hospital, Miami, FL, USA
| | - Prasoon Mohan
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
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Kim SH, Song S, Cho HS, Park CY. Hybrid Approach for Treatment of Multiple Traumatic Injuries of the Heart, Aorta, and Abdominal Organs. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:372-375. [PMID: 31624716 PMCID: PMC6785166 DOI: 10.5090/kjtcs.2019.52.5.372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 11/16/2022]
Abstract
A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.
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Affiliation(s)
- Seon Hee Kim
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital Trauma Center, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Seunghwan Song
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Ho Seong Cho
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Chan Yong Park
- Department of Trauma, Wonkwang University Hospital Trauma Center, Wonkwang University School of Medicine, Iksan, Korea
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Bazzi M, Lundgren SM, Hellström M, Fridh I, Ahlberg K, Bergbom I. The drama in the hybrid OR: video observations of work processes and staff collaboration during endovascular aortic repair. J Multidiscip Healthc 2019; 12:453-464. [PMID: 31354284 PMCID: PMC6580134 DOI: 10.2147/jmdh.s197727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions. Aim: This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR). Methods: Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors´ team typology. Results: An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure. Discussion: The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter- and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient. Conclusion: This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation.
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Affiliation(s)
- May Bazzi
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Solveig M Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Isabell Fridh
- Faculty of Caring Sciences, Work Life & Social Welfare, University of Borås, Borås, Sweden
| | - Karin Ahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Ingegerd Bergbom
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Cooper N, Roshdy M, Sciarretta JD, Kaufmann C, Duncan S, Davis J, Macedo FI. Multidisciplinary team approach in the management of popliteal artery injury. J Multidiscip Healthc 2018; 11:399-403. [PMID: 30214221 PMCID: PMC6118273 DOI: 10.2147/jmdh.s151498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Popliteal artery injuries (PAIs) remain a challenging entity and carry the greatest risk of limb loss among traumatic lower extremity vascular injuries. Operative management of traumatic popliteal vascular injuries continues to evolve. Improved diagnostic imaging and the introduction of endovascular techniques offered alternative modalities to traditional surgical management. Despite major efforts in establishing protocols and guidelines in the management of vascular trauma, optimal strategies of traumatic PAIs are still under investigation. Herein, we discussed the role of multidisciplinary team, involving trauma and endovascular surgeons, emergency department personnel, and interventional radiologists in the management of complex PAIs.
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Affiliation(s)
- Neal Cooper
- Department of Surgery, Grand Strand Health, Myrtle Beach, SC, USA,
| | - Mazen Roshdy
- Department of Surgery, Grand Strand Health, Myrtle Beach, SC, USA,
| | | | | | - Scott Duncan
- Department of Surgery, Grand Strand Health, Myrtle Beach, SC, USA,
| | - John Davis
- Department of Surgery, Grand Strand Health, Myrtle Beach, SC, USA,
| | - Francisco Igor Macedo
- Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Moore C, Kwayisi G, Esiobu P, Bashan-Gilzenrat KA, Matthews LR, Nguyen J, Moriarty N, Liggon M, Udobi K, Taha A, Childs E, Danner O. Successful treatment of massive hemothorax with class IV shock using aortography with transcatheter embolization of actively bleeding posterior left intercostal arteries after penetrating left chest trauma: A case for the hybrid OR. Int J Surg Case Rep 2018; 48:109-112. [PMID: 29885914 PMCID: PMC6041426 DOI: 10.1016/j.ijscr.2018.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 12/28/2022] Open
Abstract
Hemothorax is a common occurrence after blunt or penetrating injury to the chest. Posterior intercostal vessel hemorrhage as a cause of major intrathoracic bleeding is an infrequent source of massive bleeding. Selective angiography with trans-catheter embolization may provide a minimally invasive and efficient method of controlling bleeding refractory to surgical treatment. PRESENTATION OF CASE A 19 year-old male sustained a gunshot wound to his left chest with massive hemothorax and refractory hemorrhage. He was emergently taken to the operating room for thoracotomy and was found to have uncontrollable bleeding from the chest due to left posterior intercostal artery transection. The bleeding persisted despite multiple attempts with sutures, clips and various hemostatic agents. Thoracic aortography was undertaken and revealed active bleeding from the left 7th posterior intercostal artery, which was coil-embolized. The patient's hemodynamic status significantly improved and he was transferred to the intensive care unit. DISCUSSION Posterior intercostal bleeding is a rare cause of massive hemothorax. Bleeding from these arteries may be difficult to control due to limited exposure in that area. Transcatheter-based arterial embolization is a reliable and feasible option for arresting hemorrhage following failed attempts at hemorrhage control from thoracotomy. CONCLUSION Massive hemothorax from intercostal arterial bleeding is a rare complication after penetrating chest injury (Aoki et al., 2003). Selective, catheter-based embolization is a useful therapeutic option for hemorrhage control and can be expeditiously employed if a hybrid operating room is available.
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Affiliation(s)
| | | | - Prince Esiobu
- University of Washington School of Medicine, Seattle, WA, USA
| | | | | | | | | | | | - Kahdi Udobi
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Assad Taha
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Ed Childs
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Omar Danner
- Morehouse School of Medicine, Atlanta, GA, USA.
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Bunya N, Harada K, Kuroda Y, Toyohara T, Toyohara T, Kubota N, Kakizaki R, Irifune H, Uemura S, Narimatsu E. The effectiveness of hybrid treatment for sever multiple trauma: a case of multiple trauma for damage control laparotomy and thoracic endovascular repair. Int J Emerg Med 2017; 10:18. [PMID: 28585119 PMCID: PMC5459779 DOI: 10.1186/s12245-017-0145-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background Time is a crucial factor for the successful early management of the multi-trauma patient. Hybrid operating theaters, which support the integration of surgical treatment and interventional radiology, provide opportunities to reduce the time-to-surgery for life threatening conditions. Case presentation We describe the early successful treatment of a 54-year-old male who sustained multiple injuries when he was hit by a 1000 kg bale of wheat that fell from a height. He was admitted with hemorrhagic shock due to intra-abdominal bleeding, an unstable fracture of the pelvis, and blunt aortic injury, which was considered to be at high risk of rupture. External fixation was applied to the pelvis in the resuscitation bay, and the patient was transferred to a hybrid operating theater for treatment of both the intra-abdominal hemorrhage and blunt aortic injury. Damage control laparotomy and thoracic endovascular aortic repair were performed uneventfully. Conclusions Hybrid treatment, which combines emergency surgery and intraoperative interventional radiology, provides a prompt and appropriate management approach for the treatment of patients with severe multiple trauma and may improve patient outcomes.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tsubasa Toyohara
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takashi Toyohara
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Narumi Kubota
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hideto Irifune
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Jang JY, Shim H, Jung PY, Kim S, Bae KS. Preperitoneal pelvic packing in patients with hemodynamic instability due to severe pelvic fracture: early experience in a Korean trauma center. Scand J Trauma Resusc Emerg Med 2016; 24:3. [PMID: 26762284 PMCID: PMC4712461 DOI: 10.1186/s13049-016-0196-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mortality rate of patients with hemodynamic instability due to severe pelvic fracture is reported to be 40-60% despite a multidisciplinary treatment approach. Angioembolization and external fixation of the pelvis are the main procedures used to control bleeding in these patients. Several studies have shown that preperitoneal pelvic packing (PPP) is effective for hemorrhage control, despite being small and observational in nature. The purpose of this study was to describe a Korean trauma center's early experience with PPP in unstable patients with pelvic fractures and to evaluate its effectiveness. METHODS Between January 2012 and May 2015, 30 patients with hemodynamic instability caused by pelvic fracture were enrolled in this study. PPP has been performed in 14 patients since May 2014. Data of pelvic fracture patients with hemodynamic instability were selected from Wonju Severance Christian Hospital Pelvic Trauma Database and were analyzed retrospectively. RESULTS Mean age and mean ISS were 60.4 ± 18.8 years and 39.2 ± 8.1 in 30 unstable patients with pelvic fracture. Mean SBP was 89.1 ± 24.7 mmHg, and mean hemoglobin was 10.6 ± 2.3 g/dL. When the non-PPP group (16 patients) and the PPP group (14 patients) were compared, there was no significant difference in the age, gender, ISS, and occurrence of associated injury (p = 0.82, p = 0.23, p = 0.92, and p = 0.60, respectively). Mortality rate due to acute hemorrhage were 37.5% in the non-PPP group and 14.3% in the PPP group. In the PPP group, three patients underwent PPP in the hybrid operating room, and a laparotomy was performed in three patients. Mean systolic blood pressure increased significantly after PPP (71.6 ± 9.8 vs. 132.2 ± 36.4 mmHg, p = 0.002). CONCLUSIONS In unstable patients with pelvic fractures, PPP can be used as an effective treatment, complementary to AE, to control pelvic bleeding.
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Affiliation(s)
- Ji Young Jang
- Trauma Center, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 220-701 Ilsan-ro, Wonju-si, Gangwon-do, Republic of Korea.
| | - Hongjin Shim
- Trauma Center, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 220-701 Ilsan-ro, Wonju-si, Gangwon-do, Republic of Korea.
| | - Pil Young Jung
- Trauma Center, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 220-701 Ilsan-ro, Wonju-si, Gangwon-do, Republic of Korea.
| | - Seongyup Kim
- Trauma Center, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 220-701 Ilsan-ro, Wonju-si, Gangwon-do, Republic of Korea.
| | - Keum Seok Bae
- Trauma Center, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 220-701 Ilsan-ro, Wonju-si, Gangwon-do, Republic of Korea.
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Epstein NE. Multidisciplinary in-hospital teams improve patient outcomes: A review. Surg Neurol Int 2014; 5:S295-303. [PMID: 25289149 PMCID: PMC4173201 DOI: 10.4103/2152-7806.139612] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/12/2014] [Indexed: 01/08/2023] Open
Abstract
Background: The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Methods: Acting like “well-oiled machines,” multidisciplinary in-hospital teams include “staff” from different levels of the treatment pyramid (e.g. staff including nurses’ aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the “silo effect” by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Results: Multiple articles across diverse disciplines incorporate a variety of concepts of “teamwork” for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient “staff” satisfaction. Conclusion: Within hospitals, delivering the best medical/surgical care is a “team sport.” The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers’ performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their “well-oiled machines” enhancing the quality/safety of patient care, while enabling “staff” to optimize their performance and enhance their job satisfaction.
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Affiliation(s)
- Nancy E Epstein
- Winthrop University Hospital, Chief of Neurosurgical Spine, Education, and Research, Mineola, NY 11501, USA
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