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Granieri S, Frassini S, Cimbanassi S, Bonomi A, Paleino S, Lomaglio L, Chierici A, Bruno F, Biondi R, Di Saverio S, Khan M, Cotsoglou C. Impact of resuscitative endovascular balloon occlusion of the aorta (REBOA) in traumatic abdominal and pelvic exsanguination: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 48:3561-3574. [DOI: 10.1007/s00068-022-01955-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/13/2022] [Indexed: 12/29/2022]
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Castellini G, Gianola S, Biffi A, Porcu G, Fabbri A, Ruggieri MP, Coniglio C, Napoletano A, Coclite D, D'Angelo D, Fauci AJ, Iacorossi L, Latina R, Salomone K, Gupta S, Iannone P, Chiara O. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg 2021; 16:41. [PMID: 34384452 PMCID: PMC8358549 DOI: 10.1186/s13017-021-00386-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Multiple studies regarding the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in patients with non-compressible torso injuries and uncontrolled haemorrhagic shock were recently published. To date, the clinical evidence of the efficacy of REBOA is still debated. We aimed to conduct a systematic review assessing the clinical efficacy and safety of REBOA in patients with major trauma and uncontrolled haemorrhagic shock. Methods We systematically searched MEDLINE (PubMed), EMBASE and CENTRAL up to June 2020. All randomized controlled trials and observational studies that investigated the use of REBOA compared to resuscitative thoracotomy (RT) with/without REBOA or no-REBOA were eligible. We followed the PRISMA and MOOSE guidelines. Two authors independently extracted data and appraised the risk of bias of included studies. Effect sizes were pooled in a meta-analysis using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Primary outcomes were mortality, volume of infused blood components, health-related quality of life, time to haemorrhage control and any adverse effects. Secondary outcomes were improvement in haemodynamic status and failure/success of REBOA technique. Results We included 11 studies (5866 participants) ranging from fair to good quality. REBOA was associated with lower mortality when compared to RT (aOR 0.38; 95% CI 0.20–0.74), whereas no difference was observed when REBOA was compared to no-REBOA (aOR 1.40; 95% CI 0.79–2.46). No significant difference in health-related quality of life between REBOA and RT (p = 0.766). The most commonly reported complications were amputation, haematoma and pseudoaneurysm. Sparse data and heterogeneity of reporting for all other outcomes prevented any estimate. Conclusions Our findings on overall mortality suggest a positive effect of REBOA among non-compressible torso injuries when compared to RT but no differences compared to no-REBOA. Variability in indications and patient characteristics prevents any conclusion deserving further investigation. REBOA should be promoted in specific training programs in an experimental setting in order to test its effectiveness and a randomized trial should be planned. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-021-00386-9.
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Affiliation(s)
- Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy.
| | - Annalisa Biffi
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Andrea Fabbri
- Emergency Department, AUSL della Romagna, Forlì, Italy
| | | | - Carlo Coniglio
- Department of Anesthesiology, Intensive Care and Pre-Hospital Emergency Services, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Antonello Napoletano
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Daniela Coclite
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Daniela D'Angelo
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Alice Josephine Fauci
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Laura Iacorossi
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Roberto Latina
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Katia Salomone
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Shailvi Gupta
- University of Maryland, Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Primiano Iannone
- Istituto Superiore di Sanità, Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Rome, Italy
| | - Osvaldo Chiara
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milano, Piazza Ospedale Maggiore, Milan, Italy
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[Emergency thoracotomy in a severely injured patient after hemorrhagic shock in traumatic pelvic bleeding : Case report]. Unfallchirurg 2021; 125:568-573. [PMID: 34255104 DOI: 10.1007/s00113-021-01055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
A case of in-hospital thoracotomy with subsequent open chest cardiopulmonary resuscitation of a polytraumatized patient is reported. Emergency thoracotomies are rare interventions in challenging situations. Up to now there are only few standards or uniform education and training concepts. The indications are often a borderline decision. The aim of thoracotomy and open resuscitation in combination with a reduction in circulation, for example by cross-clamping the aorta, is to save time to address reversible causes of the hemorrhage, redirect the blood volume into the vital cerebral and coronary circulation and minimize bleeding from subdiaphragmatic bleeding sources. Ultimately, in case of doubt, the thoracotomy can be performed for the patient's benefit with the appropriate indications.
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Schimrigk J, Baulig C, Buschmann C, Ehlers J, Kleber C, Knippschild S, Leidel BA, Malysch T, Steinhausen E, Dahmen J. [Indications, procedure and outcome of prehospital emergency resuscitative thoracotomy-a systematic literature search]. Unfallchirurg 2020; 123:711-723. [PMID: 32140814 DOI: 10.1007/s00113-020-00777-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prehospital resuscitative thoracotomy (PHRT) is a controversially discussed measure for the acute treatment of traumatic cardiac arrest (TCA) recommended by the current guidelines of the European Resuscitation Council (ERC). The aim of this work is the comprehensive presentation and summary of the available literature with the underlying hypothesis that the available publications show the feasibility and survival following PHRT in patients with TCA with a good neurological outcome. METHOD A systematic literature search was performed in the databases PubMed, EMBASE, Google Scholar, Springer LINK and Cochrane. The study selection, data extraction and evaluation of bias potential were performed independently by two authors. The outcome of patients with TCA after PHRT was selected as the primary endpoint. RESULTS A total of 4616 publications were found of which 21 publications with a total of 287 patients could be included in the analyses. For a detailed descriptive analysis, 15 publications with a total of 205 patients were suitable. The TCA of these patients was most commonly caused by pericardial tamponade, thoracic vascular injuries and severe extrathoracic multiple injuries. In 24% of the cases TCA occurred in the presence of the emergency physician. Clamshell thoracotomy (53%) was used preclinically more often than anterolateral thoracotomy (47%). Of the PHRT patients after TCA 12% (25/205) left the hospital alive, 9% (n = 19/205) with good neurological outcome and 1% (n = 3/205) with poor neurological outcome (according to the Glasgow outcome scale, GOS). CONCLUSION The prognosis of TCA seems to be much better than has long been assumed. Decisive for the success of resuscitation efforts in TCA seems to be the immediate, partly invasive treatment of all reversible causes. The measures for TCA recommended by the ERC resuscitation guidelines, seem to be poorly implemented, especially in the preclinical setting. A controversy regarding the recommendations of the guidelines is the question of whether a PHRT can be successfully implemented and if the comprehensive introduction in Germany seems to be meaningful. Despite the recommendation of the guidelines, this systematic review and meta-analysis underlines the lack of high-quality evidence on PHRT, whereby a survival probability to hospital discharge of 12% was reported, of which 75% had a good neurological outcome. The risk of bias of the results in individual publications as well as in this review is high. Further systematic research in the field of preclinical trauma resuscitation is particularly necessary also for acceptance of the guidelines.
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Affiliation(s)
- J Schimrigk
- Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Baulig
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Buschmann
- Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
- AG Trauma, Deutscher Rat für Wiederbelebung - German Resuscitation Council (GRC), Ulm, Deutschland
| | - J Ehlers
- Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Kleber
- AG Trauma, Deutscher Rat für Wiederbelebung - German Resuscitation Council (GRC), Ulm, Deutschland
- Chirurgische Notaufnahme, Universitätszentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum TU Dresden, Dresden, Deutschland
| | - S Knippschild
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - B A Leidel
- Zentrale Notaufnahme, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Malysch
- Klinik für Anästhesiologie und Intensivtherapie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Deutschland
| | - E Steinhausen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland
- Ärztliche Leitung Rettungsdienst Berlin, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
| | - J Dahmen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland.
- Ärztliche Leitung Rettungsdienst Berlin, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestraße 2, 10179, Berlin, Deutschland.
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Endo A, Kojima M, Hong ZJ, Otomo Y, Coimbra R. Open-chest versus closed-chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:541. [PMID: 32873326 PMCID: PMC7465718 DOI: 10.1186/s13054-020-03259-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
Background The effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable. Although current guidelines state that the presence of signs of life (SOL) is an indication for OCCPR, scientific evidence corroborating this recommendation has been scarce. This study aimed to compare the effectiveness of OCCPR to closed-chest cardiopulmonary resuscitation (CCCPR) in severe trauma patients with SOL upon arrival at the emergency department (ED). Methods A retrospective cohort study analyzing data from the Trauma Quality Improvement Program (TQIP) database, a nationwide trauma registry in the USA, between 2010 and 2016 was conducted. Severe trauma patients who had SOL upon arrival at the hospital and received cardiopulmonary resuscitation within the first 6 h of ED admission were identified. Survival to hospital discharge was evaluated using logistic regression analysis, instrumental variable analysis, and propensity score matching analysis adjusting for potential confounders. Results A total of 2682 patients (OCCPR 1032; CCCPR 1650) were evaluated; of those 157 patients (15.2%) in the OCCPR group and 193 patients (11.7%) in the CCCPR group survived. OCCPR was significantly associated with higher survival to hospital discharge in both the logistic regression analysis (adjusted odds ratio [95% confidence interval] = 1.99 [1.42–2.79], p < 0.001) and the instrumental variable analysis (adjusted odds ratio [95% confidence interval] = 1.16 [1.02–1.31], p = 0.021). In the propensity score matching analysis, 531 matched pairs were generated, and the OCCPR group still showed significantly higher survival at hospital discharge (89 patients [16.8%] in the OCCPR group vs 58 patients [10.9%] in the CCCPR group; odds ratio [95% confidence interval] = 1.66 [1.13–2.42], p = 0.009). Conclusions Compared to CCCPR, OCCPR was associated with significantly higher survival at hospital discharge in severe trauma patients with SOL upon ED arrival. Further studies to confirm these results and to assess long-term neurologic outcomes are needed.
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Affiliation(s)
- Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Mitsuaki Kojima
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, Japan
| | - Zhi-Jie Hong
- Riverside University Health System, Comparative Effectiveness and Clinical Outcomes Research Center, 26520 Cactus Avenue, CPC Suite 102-5, Moreno Valley, CA, 92555, USA.,Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Raul Coimbra
- Riverside University Health System, Comparative Effectiveness and Clinical Outcomes Research Center, 26520 Cactus Avenue, CPC Suite 102-5, Moreno Valley, CA, 92555, USA.
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Jack MW, Wierenga JR, Bridges JP, Baltzer WI, Crosse KR. Feasibility of open-chest cardiopulmonary resuscitation through a transdiaphragmatic approach in dogs. Vet Surg 2019; 48:1042-1049. [PMID: 31120588 DOI: 10.1111/vsu.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/24/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe and evaluate the feasibility of a transdiaphragmatic (TD) approach for open-chest cardiopulmonary resuscitation (OCCPR) as an alternative to a traditional lateral thoracotomy (LT) in a canine cadaver model. STUDY DESIGN Randomized noninferiority ex vivo study. ANIMALS Fourteen canine cadavers weighing 17.4-30.2 kg. METHODS An LT and a TD approach to the heart were performed in each cadaver. The order of procedures as well as an assignment to specific operators were randomized before starting the study. Data recorded included the time between incision and initiation of cardiac compressions; time between initiation of the first suture placement and closure of the intrapleural space; time between initiation of the first suture placement and final skin suture; trauma to pulmonary, cardiac, hepatic and neurovascular structures; distance between the caval foramen and diaphragmatic incision; the intercostal space entered during LT; and appropriate closure. RESULTS The mean time between incision and initiation of cardiac compressions for the TD approach (85 ± 35 seconds) was noninferior to the LT (84 ± 28 seconds). The pleural space was closed faster after the TD approach (531 ± 276 seconds) than after the lateral approach (817 ± 294 seconds, P = .03). Total duration of closure did not differ between techniques (P = .11). There was no difference between the complication rates of each approach. CONCLUSION The TD approach did not prolong the procedure or increase the complication rate compared with an LT. CLINICAL SIGNIFICANCE This study provides evidence to support additional investigation of the TD approach for OCCPR to determine its efficacy and safety in live animals.
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Affiliation(s)
- Malcolm W Jack
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Janelle R Wierenga
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Janis P Bridges
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Wendy I Baltzer
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Katherine R Crosse
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
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REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta). Notf Rett Med 2019. [DOI: 10.1007/s10049-017-0396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Joseph B, Khan M, Jehan F, Latifi R, Rhee P. Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program. Trauma Surg Acute Care Open 2018; 3:e000201. [PMID: 30402559 PMCID: PMC6203136 DOI: 10.1136/tsaco-2018-000201] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Advancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT. METHODS A 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program. Outcome measures were utilization rates and survival trends after ERT during the 5-year period. Regression analysis was performed. RESULTS 2229 patients underwent ERT, mean age was 37±17 years, 81% were male. Overall 56% patients had penetrating mechanism, location of major injury was thorax in 48, and 71% had signs of life (SOL) on arrival. The overall survival rate was 9.6%. From 2010-2014 ERT utilization has decreased from 331/100 000 to 243/100 000 trauma admissions (p=0.002) and the survival rate has improved from 7.9% to 11.3% (p<0.001). On regression, the independent predictors of survival were penetrating mechanism, age<60 years, SOL on arrival, no prehospital CPR and ISS. No patient aged >60 years with a blunt mechanism of injury (MOI) survived, and there were no survivors above the age of 70 years, regardless of injury mechanism. DISCUSSION Utilization of ERT has been decreased during the study period along with improved survival rates. The results of our study demonstrate that performing ERT on patients aged >60 years with a blunt MOI or on any patient aged ≥70 years, regardless of MOI, is futile and should be avoided. LEVEL OF EVIDENCE Level III, prognostic studies.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Muhammad Khan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Faisal Jehan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Rifat Latifi
- Department of General Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Peter Rhee
- Division of Trauma and Acute Care Surgery, Grady Memorial Hospital, Atlanta, Georgia, USA
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Cheema F, Garcia C, Rivera AG, Chao E. CE: The Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Treating Hemorrhagic Shock from Severe Trauma. Am J Nurs 2018; 118:22-28. [PMID: 30211702 DOI: 10.1097/01.naj.0000546376.73926.5b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Hemorrhage is the leading cause of preventable death in trauma patients. In recent years, technological innovations and research efforts aimed at preventing death from hemorrhagic shock have resulted in the emergence of resuscitative endovascular balloon occlusion of the aorta (REBOA). REBOA offers a less invasive option for emergent hemorrhage control in noncompressible areas of the body without the added risks and morbidities of an ED thoracotomy. This article outlines the procedure and device used, describes the procedure's evolution, and discusses various considerations, pitfalls, and nursing implications.
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Affiliation(s)
- Fareed Cheema
- Fareed Cheema is a resident physician in the Department of Surgery, Jacobi Medical Center, Bronx, NY, where Carrie Garcia is the trauma program manager and Aksim G. Rivera and Edward Chao are attending physicians. Contact author: Edward Chao, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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10
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Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712002-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Ordoñez CA, Manzano-Nunez R, del Valle AM, Rodriguez F, Burbano P, Naranjo MP, Parra MW, Ferrada P, Solís-Velasco MA, García AF. Uso actual del balón de resucitación aórtico endovascular (REBOA) en trauma. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.rca.2017.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mancini A, Bonne A, Pirvu A, Porcu P, Bouzat P, Abba J, Arvieux C. Retrospective study of thoracotomy performed in a French level 1-trauma center. J Visc Surg 2017; 154:401-406. [PMID: 29150222 DOI: 10.1016/j.jviscsurg.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Resuscitative thoracotomy, a potentially life-saving procedure, is used exceptionally, and essentially for penetrating trauma. Most of the available literature is American while reports from Europe are sparse. We report our experience in a French level 1-trauma center. MATERIAL AND METHODS Patient records (patient age, gender, mechanism of injury, indication for emergency thoracotomy, anatomic injuries, interventions and survival) for all patients who underwent emergency thoracotomy between January 2005 and December 2015 were analyzed. RESULTS Twenty-two patients (19 males) underwent emergency thoracotomy. Median age was 27.5 (12-67) years. Twelve were performed for blunt trauma (55%) and 10 for penetrating injuries (45%). Thirteen patients presented with cardiac arrest, while nine had deep and refractory hypotension. Overall, survival was 32% (n=7). There were no survivors in the blunt trauma group while seven of ten with penetrating injuries survived. All patients presenting with cardiac arrest died. CONCLUSION The survival rate in this French retrospective study was in accordance with the literature.
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Affiliation(s)
- A Mancini
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - A Bonne
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - A Pirvu
- Service de chirurgie thoracique, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - P Porcu
- Service de chirurgie cardiaque, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - P Bouzat
- Service d'anesthésiologie et réanimation, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - J Abba
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - C Arvieux
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France.
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14
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Maegele M, Gu ZT, Huang QB, Yang H. Updated concepts on the pathophysiology and the clinical management of trauma hemorrhage and coagulopathy. Chin J Traumatol 2017; 20:125-132. [PMID: 28552329 PMCID: PMC5473714 DOI: 10.1016/j.cjtee.2017.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/24/2017] [Accepted: 03/29/2017] [Indexed: 02/04/2023] Open
Abstract
Uncontrolled hemorrhage and subsequent trauma-induced coagulopathy (TIC) are still the principle causes for preventable death after trauma and early detection and aggressive management have been associated with reduced mortality. Despite increasing knowledge about trauma resuscitation, best practice to treat this newly defined entity is still under debate. A synopsis of best current knowledge with reference to the updated European trauma guideline on the management of severe trauma hemorrhage and TIC is presented. The implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome is advocated.
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Affiliation(s)
- Marc Maegele
- Department for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr 200, D-51109 Köln, Germany,Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr 200, D-51109 Köln, Germany,Corresponding author. Department for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr 200, D-51109 Köln, Germany. Fax: +49 (0)221 89 07 30 85.Department for Trauma and Orthopedic SurgeryCologne-Merheim Medical Center (CMMC)University Witten/Herdecke (UW/H)Campus Cologne-Merheim, Ostmerheimerstr 200KölnD-51109Germany
| | - Zheng-Tao Gu
- Department of Intensive Care, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, PR China,Department of Pathophysiology, Guangdong Provincial Key Laboratory of Shock and Microcirculation Research, Southern Medical University, Guangzhou 510515, PR China
| | - Qiao-Bing Huang
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Shock and Microcirculation Research, Southern Medical University, Guangzhou 510515, PR China
| | - Hong Yang
- Department of Intensive Care, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, PR China,Department of Pathophysiology, Guangdong Provincial Key Laboratory of Shock and Microcirculation Research, Southern Medical University, Guangzhou 510515, PR China
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15
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Matsumoto H, Hara Y, Yagi T, Saito N, Mashiko K, Iida H, Motomura T, Nakayama F, Okada K, Yasumatsu H, Sakamoto T, Seo T, Konda Y, Hattori Y, Yokota H. Impact of urgent resuscitative surgery for life-threatening torso trauma. Surg Today 2016; 47:827-835. [PMID: 27888344 PMCID: PMC5486610 DOI: 10.1007/s00595-016-1451-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 10/28/2016] [Indexed: 11/28/2022]
Abstract
Purpose This study investigated the advantages of performing urgent resuscitative surgery (URS) in the emergency department (ED); namely, our URS policy, to avoid a delay in hemorrhage control for patients with severe torso trauma and unstable vital signs. Methods We divided 264 eligible cases into a URS group (n = 97) and a non-URS group (n = 167) to compare, retrospectively, the observed survival rate with the predicted survival using the Trauma and Injury Severity Score (TRISS). Results While the revised trauma score and the injury severity score were significantly lower in the URS group than in the non-URS group, the observed survival rate was significantly higher than the predicted rate in the URS (48.5 vs. 40.2%; p = 0.038). URS group patients with a systolic blood pressure (SBP) <90 mmHg and a Glasgow coma scale (GCS) score of ≥9 had significantly higher observed survival rates than predicted survival rates (0.433 vs. 0.309, p = 0.008), (0.795 vs. 0.681, p = 0.004). The implementation of damage control surgery (DCS) was found to be a significant predictor of survival (OR 5.23, 95% CI 0.113–0.526, p < 0.010). Conclusion The best indications for the URS policy are an SBP <90 mmHg, a GCS ≥9 on ED arrival, and/or the need for DCS. By implementing our URS policy, satisfactory survival of patients requiring immediate hemostatic surgery was achieved.
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Affiliation(s)
- Hisashi Matsumoto
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan. .,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yoshiaki Hara
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takanori Yagi
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Nobuyuki Saito
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuki Mashiko
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroaki Iida
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomokazu Motomura
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Fumihiko Nakayama
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuhiro Okada
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Yasumatsu
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Taigo Sakamoto
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takao Seo
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Yusuke Konda
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - You Hattori
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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16
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van Oostendorp SE, Tan ECTH, Geeraedts LMG. Prehospital control of life-threatening truncal and junctional haemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting. Scand J Trauma Resusc Emerg Med 2016; 24:110. [PMID: 27623805 PMCID: PMC5022193 DOI: 10.1186/s13049-016-0301-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/01/2016] [Indexed: 01/15/2023] Open
Abstract
Introduction Exsanguination following trauma is potentially preventable. Extremity tourniquets have been successfully implemented in military and civilian prehospital care. Prehospital control of bleeding from the torso and junctional area’s remains challenging but offers a great potential to improve survival rates. This review aims to provide an overview of potential treatment options in both clinical as preclinical state of research on truncal and junctional bleeding. Since many options have been developed for application in the military primarily, translation to the civilian situation is discussed. Methods Medline (via Pubmed) and Embase were searched to identify known and potential prehospital treatment options. Search terms were|: haemorrhage/hemorrhage, exsanguination, junctional, truncal, intra-abdominal, intrathoracic, intervention, haemostasis/hemostasis, prehospital, en route, junctional tourniquet, REBOA, resuscitative thoracotomy, emergency thoracotomy, pelvic binder, pelvic sheet, circumferential. Treatment options were listed per anatomical site: axilla, groin, thorax, abdomen and pelvis Also, the available evidence was graded in (pre) clinical stadia of research. Results Identified treatment options were wound clamps, injectable haemostatic sponges, pelvic circumferential stabilizers, resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA), intra-abdominal gas insufflation, intra-abdominal self-expanding foam, junctional and truncal tourniquets. A total of 70 papers on these aforementioned options was retrieved. No clinical reports on injectable haemostatic sponges, intra-abdominal insufflation or self-expanding foam injections and one type of junctional tourniquets were available. Conclusion Options to stop truncal and junctional traumatic haemorrhage in the prehospital arena are evolving and may offer a potentially great survival advantage. Because of differences in injury pattern, time to definitive care, different prehospital scenario’s and level of proficiency of care providers; successful translation of various military applications to the civilian situation has to be awaited. Overall, the level of evidence on the retrieved adjuncts is extremely low.
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Affiliation(s)
- S E van Oostendorp
- Department of Trauma Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - E C T H Tan
- Department of Trauma Surgery and Helicopter Emergency Medical Service, Radboud University Medical Center, Nijmegen, The Netherlands.,Royal Netherlands Army, Utrecht, The Netherlands
| | - L M G Geeraedts
- Department of Trauma Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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17
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Sano H, Tsurukiri J, Hoshiai A, Oomura T, Tanaka Y, Ohta S. Resuscitative endovascular balloon occlusion of the aorta for uncontrollable nonvariceal upper gastrointestinal bleeding. World J Emerg Surg 2016; 11:20. [PMID: 27213011 PMCID: PMC4875689 DOI: 10.1186/s13017-016-0076-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/10/2016] [Indexed: 12/02/2022] Open
Abstract
Background Although resuscitative endovascular balloon occlusion of the aorta (REBOA) in various clinical settings was found to successfully elevate central blood pressure in hemorrhagic shock, this intervention is associated with high mortality and may represent a last-ditch option for trauma patients. We conducted a retrospective study of patients with nonvariceal upper gastrointestinal bleeding (UGIB) who underwent REBOA to identify the effectiveness of REBOA and reviewed published literatures. Methods REBOA were performed by trained acute care physicians in the emergency room and intensive care unit. The deployment of balloon catheters was positioned using ultrasonography guidance. Collected data included clinical characteristics, hemorrhagic severity, blood cultures, metabolic values, blood transfusions, REBOA-related complications and mortality. A literature search using PUBMED to include “aortic occlusion” and “gastrointestinal bleeding” was conducted. Results REBOA was attempted in eight patients among 140 patients with UGIB and median age was 66 years. Systolic blood pressure significantly increased after REBOA (66 ± 20 vs. 117 ± 45 mmHg, p < 0.01) and the total occlusion time of REBOA was 80 ± 48 min. Strong positive correlations were found between total occlusion time of REBOA and lactate concentration (Spearman’s r=0.77), clinical Rockwall score (Spearman’s r=0.80), and age (Spearman’s r=0.88), respectively. Conclusion REBOA can be performed with a high degree of technical success and is effective at improving hemodynamic in patients with UGIB. Correlations between total occlusion time and high lactate levels, clinical Rockall score, and age may be important for successful use of REBOA.
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Affiliation(s)
- Hidefumi Sano
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998 Japan
| | - Junya Tsurukiri
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998 Japan
| | - Akira Hoshiai
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998 Japan
| | - Taishi Oomura
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998 Japan
| | - Yosuke Tanaka
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998 Japan
| | - Shoichi Ohta
- Emergency and Disaster Medicine, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku, Tokyo, 160-0023 Japan
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18
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Ohrt-Nissen S, Colville-Ebeling B, Kandler K, Hornbech K, Steinmetz J, Ravn J, Lehnert P. Indication for resuscitative thoracotomy in thoracic injuries-Adherence to the ATLS guidelines. A forensic autopsy based evaluation. Injury 2016; 47:1019-24. [PMID: 26563482 DOI: 10.1016/j.injury.2015.10.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/21/2015] [Accepted: 10/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The appropriate indications for Resuscitative Thoracotomy (RT) are still debated in the literature and various guidelines have been proposed. This study aimed to evaluate whether Advanced Trauma Life Support (ATLS) guidelines for RT were applied correctly and to evaluate the proportion of deceased patients with potentially reversible thoracic lesions (PRTL). METHODS The database at the Department of Forensic Medicine at Copenhagen University was queried for autopsy cases with thoracic lesions indicated by the SNOMED autopsy coding system. Patients were included if thoracic lesions were caused by a traumatic event with trauma team activation. Patient cases were blinded for any surgical intervention and evaluated independently by two reviewers for indications or contraindications for RT as determined by the ATLS guidelines. Second, autopsy reports were evaluated for the presence of PRTL. RESULTS Sixty-seven patients met the inclusion criteria. Two were excluded due to insufficient data. The overall agreement with guidelines was 86% and 77% for blunt and penetrating trauma, respectively. For patients submitted to RT the overall agreement with guidelines was 63% being 45% and 74% for blunt and penetrating trauma, respectively. For patients who did not undergo RT the agreement with guidelines was 100%. In all cases where RT was performed in agreement between guidelines and the clinical decision the autopsy reports showed PRTL in 16 (84%) patients. In cases of non-agreement PRTL were found in 9 (82%) patients. CONCLUSIONS Agreement with ATLS guidelines for RT was 63% for intervention and 100% for non-intervention in deceased patients with thoracic trauma. Agreement was higher for penetrating trauma than for blunt trauma. The adherence to guidelines did not improve the ability to predict autopsy findings of PRTL. Although the study has methodical limitations it represents a novel approach to the evaluation of the clinical use of RT guidelines.
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Affiliation(s)
- S Ohrt-Nissen
- Department of Thoracic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark.
| | - B Colville-Ebeling
- Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark.
| | - K Kandler
- Department of Thoracic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark.
| | - K Hornbech
- Department of Thoracic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark.
| | - J Steinmetz
- Department of Anesthesiology and Trauma Centre, HOC, Rigshospitalet, Copenhagen, Denmark.
| | - J Ravn
- Department of Thoracic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark.
| | - P Lehnert
- Department of Thoracic Surgery, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark.
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19
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20
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Navsaria PH, Chowdhury S, Nicol AJ, Edu S, Naidoo N. Penetrating Trauma to the Mediastinal Vessels: a Taxing Injury. CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Anesthetic Considerations and Ventilation Strategies in Cardiothoracic Trauma. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0149-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Tsurukiri J, Akamine I, Sato T, Sakurai M, Okumura E, Moriya M, Yamanaka H, Ohta S. Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrahgic shock as an adjunct to haemostatic procedures in the acute care setting. Scand J Trauma Resusc Emerg Med 2016; 24:13. [PMID: 26861070 PMCID: PMC4748599 DOI: 10.1186/s13049-016-0205-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/02/2016] [Indexed: 02/01/2023] Open
Abstract
Background Haemorrhagic shock is a major cause of death in the acute care setting. Since 2009, our emergency department has used intra-aortic balloon occlusion (IABO) catheters for resuscitative endovascular balloon occlusion of the aorta (REBOA). Methods REBOA procedures were performed by one or two trained acute care physicians in the emergency room (ER) and intensive care unit (ICU). IABO catheters were positioned using ultrasonography. Collected data included clinical characteristics, haemorrhagic severity, blood cultures, metabolic values, blood transfusions, REBOA-related complications and mortality. Results Subjects comprised 25 patients (trauma, n = 16; non-trauma, n = 9) with a median age of 69 years and a median shock index of 1.4. REBOA was achieved in 22 patients, but failed in three elderly trauma patients. Systolic blood pressure significantly increased after REBOA (107 vs. 71 mmHg, p < 0.01). Five trauma patients (20 %) died in ER, and mortality rates within 24 h and 60 days were 20 % and 12 %, respectively. No REBOA-related complications were encountered. The total occlusion time of REBOA was significantly lesser in survivors than that in non-survivors (52 vs. 97 min, p < 0.01). Significantly positive correlations were found between total occlusion time of REBOA and shock index (Spearman’s r = 0.6) and lactate concentration (Spearman’s r = 0.7) in survivors. Conclusion REBOA can be performed in ER and ICU with a high degree of technical success. Furthermore, correlations between occlusion time and initial high lactate levels and shock index may be important because prolonged occlusion is associated with a poorer outcome.
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Affiliation(s)
- Junya Tsurukiri
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan.
| | - Itsurou Akamine
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Takao Sato
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Masatsugu Sakurai
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Eitaro Okumura
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Mariko Moriya
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Hiroshi Yamanaka
- Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0998, Japan
| | - Shoichi Ohta
- Emergency and Disaster Medicine, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku , Shinjuku, Tokyo, 160-0023, Japan
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23
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Resuscitative endovascular balloon occlusion of the aorta for hemorrhage control: Past, present, and future. J Trauma Acute Care Surg 2016; 79:S236-42. [PMID: 26406436 DOI: 10.1097/ta.0000000000000770] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. J Trauma Acute Care Surg 2015; 79:523-30; discussion 530-2. [PMID: 26402524 DOI: 10.1097/ta.0000000000000809] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemorrhage remains the leading cause of death in trauma patients. Proximal aortic occlusion, usually performed by direct aortic cross-clamping via thoracotomy, can provide temporary hemodynamic stability, permitting definitive injury repair. Resuscitative endovascular balloon occlusion of the aorta (REBOA) uses a minimally invasive, transfemoral balloon catheter, which is rapidly inserted retrograde and inflated for aortic occlusion, and may control inflow and allow time for hemostasis. We compared resuscitative thoracotomy with aortic cross-clamping (RT) with REBOA in trauma patients in profound hemorrhagic shock. METHODS Trauma registry data was used to compare all patients undergoing RT or REBOA during an 18-month period from two Level 1 trauma centers. RESULTS There was no difference between RT (n = 72) and REBOA groups (n = 24) in terms of demographics, mechanism of injury, or Injury Severity Scores (ISSs). There was no difference in chest and abdominal Abbreviated Injury Scale (AIS) scores between the groups. However, the RT patients had lower extremity AIS score as compared with REBOA patients (1.5 [0-3] vs. 4 [3-4], p < 0.001). Of the 72 RT patients, 45 (62.5%) died in the emergency department, 6 (8.3%) died in the operating room, and 14 (19.4%) died in the intensive care unit. Of the 24 REBOA patients, 4 (16.6%) died in the emergency department, 3 (12.5%) died in the operating room, and 8 (33.3%) died in the intensive care unit. In comparing location of death between the RT and REBOA groups, there were a significantly higher number of deaths in the emergency department among the RT patients as compared with the REBOA patients (62.5% vs. 16.7%, p < 0.001). REBOA had fewer early deaths and improved overall survival as compared with RT (37.5% vs. 9.7%, p = 0.003). CONCLUSION REBOA is feasible and controls noncompressible truncal hemorrhage in trauma patients in profound shock. Patients undergoing REBOA have improved overall survival and fewer early deaths as compared with patients undergoing RT. LEVEL OF EVIDENCE Therapeutic study, level IV.
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25
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Abstract
Pre-hospital care requires a broad skillset. One of the most challenging aspects of pre-hospital care is performing surgical procedures. The indications and evidence for performing pre-hospital surgical airway, thoracostomy, thoracotomy, caesarean section and amputation are discussed. Where evidence for the procedure is lacking from pre-hospital care, evidence from in-hospital experience is sought.
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26
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A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review. Eur J Trauma Emerg Surg 2015; 42:585-592. [PMID: 26416402 DOI: 10.1007/s00068-015-0574-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm. AIMS We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma. METHODS A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented. RESULTS Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients. CONCLUSION EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.
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27
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Flaris AN, Simms ER, Prat N, Reynard F, Caillot JL, Voiglio EJ. Clamshell incision versus left anterolateral thoracotomy. Which one is faster when performing a resuscitative thoracotomy? The tortoise and the hare revisited. World J Surg 2015; 39:1306-11. [PMID: 25561192 DOI: 10.1007/s00268-014-2924-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The clamshell incision (CI) offers a better exposure than the left anterolateral thoracotomy (LAT) as a resuscitative thoracotomy. Most surgeons will have to manage a heart wound only once or twice in their career. The patient's survival depends on how fast the surgeon can control the heart wound; however, it is unclear which of the two incisions allows for faster control in the hands of inexperienced surgeons. The aim of this study was to compare the time needed to access and control a standardized stab wound to the right ventricle, by inexperienced surgical trainees, by LAT or CI; we hypothesized that the CI does not take longer than the LAT. METHODS Sixteen residents were shown a video on how to perform both procedures. They were randomly assigned to control a standardized stab wound of the right ventricle on perfused human cadavers by LAT (n = 8) or CI (n = 8). Access time (skin to maximal exposure), control time (maximal exposure until control of the heart wound) and total time (the sum of access and control times) were recorded. RESULTS Total time was 6.62 min [3.20-8.14] (median [interquartile range]) for LAT and 4.63 min [3.17-6.73] for CI (p = 0.46). Access time was 2.39 min [1.21-2.76] for LAT and 2.33 min [1.58-4.86] for CI (p = 0.34). Control time was 4.16 min [2.32-5.49] for LAT and 1.85 min [1.38-2.23] for CI (p = 0.018). CONCLUSIONS The time needed from skin incision until cardiac wound control via CI was not longer than via LAT and the easier control of the cardiac wound when using CI was confirmed.
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Affiliation(s)
- Alexandros N Flaris
- Faculté de Médecine Lyon Est, Université Lyon 1, UMR T9405, 69003, Lyon, France,
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von Vopelius-Feldt J, Coulter A, Benger J. The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest. Resuscitation 2015; 96:290-5. [PMID: 26375661 DOI: 10.1016/j.resuscitation.2015.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/26/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
AIM To assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital cardiac arrest (OHCA). METHODS We undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research. RESULTS 1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p<0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89-2.67, p=0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results. CONCLUSION Pre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies. Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.
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Affiliation(s)
- Johannes von Vopelius-Feldt
- Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom.
| | - Archibald Coulter
- North Bristol NHS Trust, Southmead Road, BS10 5NB Bristol, United Kingdom
| | - Jonathan Benger
- Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom; University of the West of England, Bristol, United Kingdom
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Emergency resuscitative thoracotomy performed in European civilian trauma patients with blunt or penetrating injuries: a systematic review. Eur J Trauma Emerg Surg 2015; 42:677-685. [PMID: 26280486 PMCID: PMC5124032 DOI: 10.1007/s00068-015-0559-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/31/2015] [Indexed: 10/26/2022]
Abstract
PURPOSE Emergency resuscitative thoracotomy (ERT) is a lifesaving procedure in selected patients. Indications are still being debated, but outcome in blunt trauma is believed to be poor. Recent reports from European populations, where blunt trauma predominates, have suggested favorable outcome also in blunt trauma. Our aim was to identify all European studies reported over the last decade and compare reported outcomes to existing knowledge. METHODS We performed a systematic literature search according to PRISMA guidelines (January 1st, 2004 to December 31st, 2014). The "grey literature" was included by searching Google Scholar. Qualitative comparison of studies and outcomes was done. RESULTS A total of 8 articles from Europe were included originating from Croatia, Norway (n = 2), Denmark, Iceland, the Netherlands, Scotland, and Switzerland. Of 376 resuscitative thoracotomies, 193 (51.3 %) were for blunt trauma. Male:female distribution was 3.5:1. The collectively reported overall survival was 42.8 % (n = 161), with 25.4 % (49 of 193) blunt trauma and 61.2 % (112 of 183) penetrating injuries. When strictly including those ERTs designated as done in the emergency department for blunt mechanism (n = 139) only, a total of 18 patients survived (12.9 %). Survival after EDTs for penetrating trauma was 41.6 % (37 of 89). Neurological outcome (reported in 5 of 8 studies) reported favorable neurological long-term outcome in the majority of survivors, even after blunt trauma. None referred to Glasgow Outcome Score. Heterogeneity in the studies prevented outcome analyses by formal quantitative meta-analysis. CONCLUSION The reported outcome after ERT in European civilian trauma populations is favorable, with one in every four ERTs in the ED surviving. Notably, outcome is at variance with previously reported collective data, in particular for blunt trauma. Multicenter, prospective, observational data are needed to validate the modern role of ERT in blunt trauma.
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Chico-Fernández M, Terceros-Almanza LL, Mudarra-Reche CC. Innovation and new trends in critical trauma disease. Med Intensiva 2014; 39:179-88. [PMID: 25449666 DOI: 10.1016/j.medin.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/05/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
Abstract
The management of critical trauma disease (CTD) has always trends the trends in military war experiences. These conflicts have historically revolutionized clinical concepts, clinical practice guidelines and medical devices, and have marked future lines of research and aspects of training and learning in severe trauma care. Moreover, in the civil setting, the development of intensive care, technological advances and the testing of our healthcare systems in the management of multiple victims, hasve also led to a need for innovation in our trauma care systems.
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Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC.
| | - L L Terceros-Almanza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC
| | - C C Mudarra-Reche
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo de Trauma y Neurocríticos de la SEMICYUC
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