1
|
Huang CY, Chou SE, Huang CY, Tsai CH, Hsu SY, Hsieh CH. Role of the Stress Index in Predicting Mortality among Patients with Traumatic Femoral Fractures. Diagnostics (Basel) 2024; 14:1508. [PMID: 39061646 PMCID: PMC11275851 DOI: 10.3390/diagnostics14141508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Traumatic femoral fractures, often resulting from high-energy impacts such as traffic accidents, necessitate immediate management to avoid severe complications. The Stress Index (SI), defined as the glucose-to-potassium ratio, serves as a predictor of mortality and adverse outcomes in various trauma contexts. This study aims to evaluate the prognostic value of the SI in patients with traumatic femoral fractures. METHODS This retrospective cohort study included adult trauma patients aged 20 or above with traumatic femoral fractures from the Trauma Registry System at a level 1 trauma center in southern Taiwan between 1 January 2009 and 31 December 2022. At the emergency room, serum electrolyte levels were assessed using baseline laboratory testing. By dividing blood glucose (mg/dL) by potassium (mEq/L), the SI was calculated. The best cut-off value of the SI for predicting mortality was determined using the Area Under the Curve (AUC) of Receiver Operating Characteristic (ROC). RESULTS A total of 3717 patients made up the final group, of which 3653 survived and 64 died. In comparison to survivors, deceased patients had substantially higher blood glucose levels (199.3 vs. 159.0 mg/dL, p < 0.001) and SIs (53.1 vs. 41.6, p < 0.001). The optimal SI cut-off value for predicting mortality was 49.7, with a sensitivity of 53.1% and a specificity of 78.7% (AUC = 0.609). High SI was associated with increased mortality (4.2% vs. 1.0%, p < 0.001) and longer hospital stays (12.8 vs. 9.5 days, p < 0.001). The adjusted odds ratios of mortality, controlled by comorbidities, the Glasgow Coma Scale, and the Injury Severity Score, were significantly higher in patients with a higher SI (AOR 2.05, p = 0.016) than those with a lower SI. CONCLUSIONS Elevated SI upon admission correlates with higher mortality and extended hospital stay in patients with traumatic femoral fractures. Although the SI has a moderate predictive value, it remains a useful early risk assessment tool, necessitating further prospective, multi-center studies for validation and standardization.
Collapse
Affiliation(s)
- Ching-Ya Huang
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan;
| | - Sheng-En Chou
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan;
| | - Chun-Ying Huang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan; (C.-Y.H.); (C.-H.T.); (S.-Y.H.)
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan; (C.-Y.H.); (C.-H.T.); (S.-Y.H.)
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan; (C.-Y.H.); (C.-H.T.); (S.-Y.H.)
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan;
| |
Collapse
|
2
|
Huang CY, Rau CS, Huang CY, Su WT, Hsu SY, Hsieh CH. The Stress Index as a Predictor of Mortality in Patients with Isolated Moderate to Severe Traumatic Brain Injury. Diagnostics (Basel) 2024; 14:1244. [PMID: 38928658 PMCID: PMC11203316 DOI: 10.3390/diagnostics14121244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The Stress Index (SI), calculated as the ratio of blood glucose to serum potassium levels, is a promising prognostic marker in various acute care settings. This study aimed to evaluate the utility of the SI for predicting mortality in patients with isolated moderate-to-severe traumatic brain injury (TBI). METHODS This retrospective cohort study included adult trauma patients (aged ≥ 20 years) with isolated moderate to severe TBI (Abbreviated Injury Scale ≥ 3 for only head region) treated from 2009-2022. The SI was computed from the initial glucose and potassium levels upon arrival at the emergency department. Logistic regression models were used to assess the association between the SI and mortality after adjusting for relevant covariates. The most effective threshold value of the SI for predicting mortality was identified using receiver operating characteristic (ROC) analysis. RESULTS Among the 4357 patients with isolated moderate and severe TBI, 463 (10.6%) died. Deceased patients had a significantly higher SI (61.7 vs. 44.1, p < 0.001). In multivariate analysis, higher SI independently predicted greater mortality risk (odds ratio (OR) 6.70, 95% confidence interval (CI) 1.66-26.99, p = 0.007). The optimal SI cutoff for predicting mortality was 48.50 (sensitivity 62.0%, specificity 71.4%, area under the curve 0.724). Patients with SI ≥ 48.5 had nearly two-fold higher adjusted mortality odds compared to those below the threshold (adjusted OR 1.94, 95% CI 1.51-2.50, p < 0.001). CONCLUSIONS SI is a useful predictor of mortality in patients with isolated moderate-to-severe TBI. Incorporating SI with standard clinical assessments could enhance risk stratification and management approaches for this patient population.
Collapse
Affiliation(s)
- Ching-Ya Huang
- Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Chun-Ying Huang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-Y.H.); (W.-T.S.); (S.-Y.H.)
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-Y.H.); (W.-T.S.); (S.-Y.H.)
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-Y.H.); (W.-T.S.); (S.-Y.H.)
| | - Ching-Hua Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-Y.H.); (W.-T.S.); (S.-Y.H.)
| |
Collapse
|
3
|
Alamri FF, Almarghalani DA, Alraddadi EA, Alharbi A, Algarni HS, Mulla OM, Alhazmi AM, Alotaibi TA, Beheiry DH, Alsubaie AS, Alkhiri A, Alatawi Y, Alzahrani MS, Hakami AY, Alamri A, Al Sulaiman K. The utility of serum glucose potassium ratio as a predictive factor for haemorrhagic transformation, stroke recurrence, and mortality among ischemic stroke patients. Saudi Pharm J 2024; 32:102082. [PMID: 38690210 PMCID: PMC11059537 DOI: 10.1016/j.jsps.2024.102082] [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: 03/03/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
Background and Objective Glucose-Potassium Ratio (GPR) has emerged as a biomarker in several pathophysiological conditions. However, the association between GPR and long-term outcomes in stroke patients has not been investigated. Our study evaluated the applicability of baseline GPR as a predictive prognostic tool for clinical outcomes in ischemic stroke patients. Methods The multicenter retrospective cohort study included acute-subacute adult ischemic stroke patients who had their baseline serum GPR levels measured. Eligible patients were categorized into two sub-cohorts based on the baseline GPR levels (<1.67 vs. ≥ 1.67). The primary outcome was the incidence of 30-day hemorrhagic transformation, while stroke recurrence, and all-cause mortality within twelve months, were considered secondary. Results Among 4083 patients screened, 1047 were included in the current study. In comparison with GPR < 1.67 group, patients with ≥ 1.67 GPR had a significantly higher ratio of all-cause mortality within twelve months (aHR 2.07 [95 % CI 1.21-3.75] p = 0.01), and higher ratio of 30-day hemorrhagic transformation but failed to reach the statistical significance (aHR 1.60 [95 % CI 0.95-2.79], p = 0.08). Conclusion Overall, baseline GPR serum is an independent predictor of all-cause mortality within twelve months in patients with acute and subacute ischemic stroke. Further clinical studies are necessary to validate these findings.
Collapse
Affiliation(s)
- Faisal F. Alamri
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Salman Center for Disability Research, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Daniyah A. Almarghalani
- Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944 Saudi Arabia
- Stroke Research Unit, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Eman A. Alraddadi
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah Alharbi
- Department of Neurology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Hajar S. Algarni
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Oyoon M. Mulla
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Deema H. Beheiry
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah S. Alsubaie
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alkhiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Yasser Alatawi
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Mohammad S. Alzahrani
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Alqassem Y. Hakami
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Aser Alamri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard – Health Affairs., Riyadh, Saudi Arabia
- Saudi Critical Care Pharmacy Research (SCAPE) Platform., Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Tsuchiya R, Ooigawa H, Kimura T, Tabata S, Maeda T, Sato H, Suzuki K, Ohara Y, Ooya Y, Nemoto M, Kurita H. Study of certain easily available biochemical markers in prognostication in severe traumatic brain injury requiring surgery. Surg Neurol Int 2023; 14:410. [PMID: 38213429 PMCID: PMC10783664 DOI: 10.25259/sni_544_2023] [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: 06/28/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
Background This study aimed to identify easily available prognostic factors in severe traumatic brain injury (TBI) patients undergoing craniotomy. Methods We retrospectively analyzed the clinical characteristics (age, sex, Glasgow coma scale score, cause of TBI, and oral antithrombotic drug use), laboratory parameters (hemoglobin, sodium, C-reactive protein, D-dimer, activated partial thromboplastin time, prothrombin time-international normalized ratio, and glucose-potassium [GP] ratio), and neuroradiological findings of 132 patients who underwent craniotomy for severe TBI in our hospital between January 2015 and December 2021. The patients were divided into two groups: Those with fatal clinical outcomes and those with non-fatal clinical outcomes, and compared between the two groups. Results The patients comprised 79 (59.8%) male and 53 (40.2%) female patients. Their mean age was 67 ± 17 years (range, 16-94 years). Computed tomography revealed acute subdural hematoma in 108 (81.8%) patients, acute epidural hematoma in 31 (23.5%), traumatic brain contusion in 39 (29.5%), and traumatic subarachnoid hemorrhage in 62 (47.0%). All 132 patients underwent craniotomy, and 41 eventually died. There were significant differences in the D-dimer, GP ratio, and optic nerve sheath diameter between the groups (all P < 0.01). Multivariate logistic regression analysis showed elevated GP ratio and D-dimer were associated with the death group (P < 0.01, P < 0.01, respectively). A GP ratio of >42 was the optimal cutoff value for the prediction of a fatal outcome of TBI (sensitivity, 85.4%; specificity, 51.1%). Conclusion The GP ratio and D-dimer were significantly associated with poor outcomes of TBI. A GP ratio of >42 could be a predictor of a fatal outcome of TBI.
Collapse
Affiliation(s)
- Ryosuke Tsuchiya
- Department of Neurosurgery, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Hidetoshi Ooigawa
- Department of Neurosurgery, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Tatsuki Kimura
- Department of Neurosurgery, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Shinya Tabata
- Department of Neurosurgery, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Takuma Maeda
- Department of Neurosurgery, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Hiroki Sato
- Department of Neurosurgery, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Kaima Suzuki
- Department of Neurosurgery, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Yasuhiro Ohara
- Department of Critical Care and Emergency, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Yoshitaka Ooya
- Department of Critical Care and Emergency, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Manabu Nemoto
- Department of Critical Care and Emergency, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| | - Hiroki Kurita
- Department of Neurosurgery, Saitama Medical University International Medical Center, Yamane, Hidaka, Japan
| |
Collapse
|
5
|
Kim KH. Letter to the Editor: Is the Glucose/Potassium Ratio Reliable to Predict Patient Outcomes for Traumatic Brain Injury? Korean J Neurotrauma 2023; 19:403-404. [PMID: 37840620 PMCID: PMC10567533 DOI: 10.13004/kjnt.2023.19.e46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Kyung Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| |
Collapse
|
6
|
Marini JI, Sein ME. The Role of the Glucose Potassium Ratio in the Management of Traumatic Brain Injury. Korean J Neurotrauma 2023; 19:82-89. [PMID: 37051030 PMCID: PMC10083449 DOI: 10.13004/kjnt.2023.19.e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 03/22/2023] Open
Abstract
Objective Traumatic brain injury (TBI) has become a worldwide public health issue, raising concerns about which tool might be useful to guide initial management at hospital admission, especially to decide whether the patient would benefit from an opportune surgical intervention. Recently, the glucose-to-potassium ratio has more accurate predictive values than other biomarkers and is useful for its simplicity to obtain. To correlate each biomarker with the outcome for every patient with TBI. Methods The analysis included patients treated in a single institution between 2020 and 2021, diagnosed with mild TBI that required neurosurgery, moderate or severe TBI. Blood samples were obtained at admission, and the glucose-to-potassium ratio was calculated retrospectively. Then, these values and other variables were compared with the outcome at 6 and 12 months. Extracranial lesions that directly contributed to the outcome, a Glasgow Coma Scale of 3 and below, hemodynamic instability, and cardiac arrest were exclusion criteria. Results Forty-seven patients who reached the criteria were examined, 35 (74%) had a favorable outcome and 12 (26%) a poor one. The only biomarker significantly related to the outcome was the glucose-to-potassium ratio in both the bivariate and multivariate analysis (p=0.04; odds ratio, 8.61; 95% confidence interval, 1.07-69.6). Conclusion An increase in the glucose-to-potassium ratio was the only biomarker associated with poor outcomes and increased mortality.
Collapse
Affiliation(s)
| | - Matías Emmanuel Sein
- Department of Neurosurgery, Hospital San Martín, La Plata, Argentina
- Department of Neurosurgery, Hospital Italiano, La Plata, Argentina
| |
Collapse
|
7
|
Sharif AF, Fayed MM. Assessment of the Serum Glucose/Potassium GLU/K Ratio as a Predictor of Intermediate Syndrome Following Acute Anticholinesterase Exposure. Neurotoxicology 2022; 89:161-173. [PMID: 35149144 DOI: 10.1016/j.neuro.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/10/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The widespread use of anticholinesterase-containing pesticides accounts for the considerable morbidity and mortality in Egypt and worldwide. AIM Few studies have investigated the predictors of intermediate syndrome (IMS). Therefore, in this study, we assessed the adequacy of the serum glucose/potassium (GLU/K) ratio as an early reliable tool to predict IMS incidence following intoxication with acute anticholinesterase compounds. METHODS A prospective cross-sectional study was conducted among patients who presented to Tanta University Poison Control Center, Egypt, and were diagnosed with acute anticholinesterase intoxication between January and August, 2021. Patients were categorized based on the primary outcome into IMS (+) and IMS (-) groups. RESULTS Overall, 243 patients were included, among whom 44 (18.1%) had IMS as the complication. Younger individuals with age ranging between 18 and <25 years constituted the main exposed age category in both groups. Vomiting and abdominal colic were the most commonly noted complaints in the included patients (94.2% and 63.8% of patients, respectively). The delay, length of hospital stay, mean blood pressure, O2 saturation, Glasgow Coma Scale score, random blood glucose level, K concentration, GLU/K ratio, and dose of atropine administered were significant IMS predictors on an individual basis, and the GLU/K ratio was the most significant IMS predictor. At a cutoff value of >41.07%, the GLU/K ratio could significantly predict IMS (areas under the curves = 0.971, p < 0.001) with 93% accuracy, 93.2% sensitivity, and 93% specificity. CONCLUSION Although the clear pathophysiology of IMS remains to be elucidated, our results provide insight into the significant contribution of neurological affection, apart from the well-known direct toxic effect on muscles. Moreover, we demonstrated a significant association between the development of IMS and severity of organophosphorus compounds' exposure. Physicians should be vigilant to detect IMS early upon admission using the GLU/K ratio, which is a useful early IMS predictor.
Collapse
Affiliation(s)
- Asmaa Fady Sharif
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Egypt; Clinical Medical Sciences Department, College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Manar Maher Fayed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Egypt.
| |
Collapse
|
8
|
Liu C, Yuan D, Crawford R, Sarkar R, Hu B. Directly Cooling Gut Prevents Mortality in the Rat Model of Reboa Management of Lethal Hemorrhage. Shock 2021; 56:813-823. [PMID: 33555843 PMCID: PMC8329109 DOI: 10.1097/shk.0000000000001744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving technique for the management of lethal torso hemorrhage. Its benefit, however, must be weighed against the lethal distal organ ischemia-reperfusion injury (IRI). This study uses a novel direct gut cooling technique to manage the distal organ IRI. METHODS A rat lethal hemorrhage model was established by bleeding of 50% of the estimated total blood volume via inferior vena cava. A novel TransRectal Intra-Colon (TRIC) temperature management device was positioned in the descending colon either to maintain intra-colon temperature at 37°C or 12°C. The upper body temperature was maintained at as close to 37°C as possible in both groups. A 2F Fogarty balloon catheter was inserted via the femoral artery into the descending thoracic aorta for the implementation of REBOA. After REBOA, the balloon was deflated, and the shed blood was returned. The temperature managements were continued for additional 180 to 270 min during the post-REBOA period. RESULTS All rats subjected to REBOA management of lethal hemorrhage at 37°C had severe histopathological gut and abdominal organ IRI, severe functional deficits, and died within 24 h with 100% mortality. By contrast, directly cooling the colon to 10°C to 12°C with the novel TRIC device abolished mortality, and dramatically improved ABG parameters, prevented the abdominal organ injury, and reduced the functional deficits during the 7-day post-REBOA period. CONCLUSIONS Direct trans-rectal colon cooling during REBOA management of lethal hemorrhage offers extraordinary functional improvement and amazing tissue protection, and abolishes mortality.
Collapse
Affiliation(s)
- Chunli Liu
- Veterans Affairs Maryland Health Center System,10 North Greene Street, Baltimore, MD 21201
| | - Dong Yuan
- Departments of Anesthesiology and Surgery, Shock Trauma and Anesthesiology Research Center University of Maryland School of Medicine, Baltimore, MD
| | - Robert Crawford
- Departments of Anesthesiology and Surgery, Shock Trauma and Anesthesiology Research Center University of Maryland School of Medicine, Baltimore, MD
| | - Rajabrata Sarkar
- Departments of Anesthesiology and Surgery, Shock Trauma and Anesthesiology Research Center University of Maryland School of Medicine, Baltimore, MD
| | - Bingren Hu
- Departments of Anesthesiology and Surgery, Shock Trauma and Anesthesiology Research Center University of Maryland School of Medicine, Baltimore, MD
- Veterans Affairs Maryland Health Center System,10 North Greene Street, Baltimore, MD 21201
| |
Collapse
|