Indirect Hemorrhage Control: Angiography/Embolization (AE)

Abstract Context Some medical schools integrate STOP THE BLEED® training into their curricula to teach students how to identify and stop life threatening bleeds; these classes that are taught as single day didactic and hands-on training sessions without posttraining reviews. To improve retention and confidence in hemorrhage control, additional review opportunities are necessary. Objectives To investigate whether intermittent STOP THE BLEED® reviews were effective for long term retention of hemorrhage control skills and improving perceived confidence. Methods First year osteopathic medical students were asked to complete an eight item survey (five Likert scale and three quiz format questions) before (pretraining) and after (posttraining) completing a STOP THE BLEED® training session. After the surveys were collected, students were randomly assigned to one of two study groups. Over a 12 week intervention period, each group watched a 4 min STOP THE BLEED® review video (intervention group) or a “distractor” video (control group) at 4 week intervals. After the 12 weeks, the students were asked to complete an 11 item survey. Results Scores on the posttraining survey were higher than the pretraining survey. The median score on the five Likert scale items was 23 points for the posttraining survey and 14 points for the pretraining survey. Two of the three knowledge based quiz format questions significantly improved from pretraining to posttraining (both p<0.001). On the 11 item postintervention survey, both groups performed similarly on the three quiz questions (all p>0.18), but the intervention group had much higher scores on the Likert scale items than the control group regarding their confidence in their ability to identify and control bleeding (intervention group median = 21.4 points vs. control group median = 16.8 points). Conclusions Intermittent review videos for STOP THE BLEED® training improved medical students’ confidence in their hemorrhage control skills, but the videos did not improve their ability to correctly answer quiz-format questions compared with the control group.

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Intra-abdominal Inferior Vena Cava Injuries: Operative Strategies and Outcomes

The American Surgeon ◽

10.1177/0003134820973395 ◽

2020 ◽

pp. 000313482097339

Author(s):

Christine A. Castater ◽

Margo Carlin ◽

Virginia D. Parker ◽

Chris Sciarretta ◽

Deepika Koganti ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Mortality Rates ◽

Volume Resuscitation ◽

Vascular Injuries ◽

Trauma Centers ◽

Review Of The Literature ◽

Hemorrhage Control ◽

Operative Strategies

Visceral vascular injuries are relatively uncommon even in busy urban trauma centers. The inferior vena cava (IVC) is the most frequently injured visceral vein and can be a complex operative challenge. Despite advances in early volume resuscitation, improved transport times, prompt operative intervention, and hemorrhage control, mortality rates have remained largely unchanged. This article conducts an in-depth review of the literature surrounding IVC injuries and a detailed discussion of operative strategies and management as survivability is ultimately dependent on the grade of injury, location, and the presence of hemorrhagic shock.

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Determination of optimal deployment strategy for REBOA in patients with non-compressible hemorrhage below the diaphragm

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000660 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000660

Author(s):

Nicholas L Johnson ◽

Charles E Wade ◽

Erin E Fox ◽

David E Meyer ◽

Charles J Fox ◽

...

Keyword(s):

Primary Source ◽

Multiple Organ ◽

Balloon Occlusion ◽

Hemorrhage Control ◽

Level Of Evidence ◽

Occlusion Time ◽

Deployment Strategy ◽

Multicenter Prospective Observational Study ◽

Selection Algorithms ◽

Post Hoc

BackgroundNon-compressible truncal hemorrhage (NCTH) is the leading cause of preventable death after trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) achieves temporary hemorrhage control, supporting cardiac and cerebral perfusion prior to definitive hemostasis. Aortic zone selection algorithms vary among institutions. We evaluated the efficacy of an algorithm for REBOA use.MethodsA multicenter prospective, observational study conducted at six level 1 trauma centers over 12 months. Inclusion criteria were age >15 years with evidence of infradiaphragmatic NCTH needing emergent hemorrhage control within 60 min of ED arrival. An algorithm characterized by the results of focused assessment with sonography in trauma and pelvic X-ray was assessed post hoc for efficacy in a cohort of patients receiving REBOA.ResultsOf the 8166 patients screened, 78 patients had a REBOA placed. 21 patients were excluded, leaving 57 patients for analysis. The algorithm ensures REBOA deployment proximal to hemorrhage source to control bleeding in 98.2% of cases and accurately predicts the optimal REBOA zone in 78.9% of cases. If the algorithm was violated, bleeding was optimally controlled in only 43.8% (p=0.01). Three (75.0%) of the patients that received an inappropriate zone 1 REBOA died, two from multiple organ failure (MOF). All three patients that died with an inappropriate zone 3 REBOA died from exsanguination.DiscussionThis algorithm ensures proximal hemorrhage control and accurately predicts the primary source of hemorrhage. We propose a new algorithm that will be more inclusive. A zone 3 REBOA should not be performed when a zone 1 is indicated by the algorithm as 100% of these patients exsanguinated. MOF, perhaps from visceral ischemia in patients with an inappropriate zone 1 REBOA, may have been prevented with zone 3 placement or limited zone 1 occlusion time.Level of evidenceLevel III.

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Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01586-9 ◽

2021 ◽

Author(s):

David T. McGreevy ◽

Mitra Sadeghi ◽

Kristofer F. Nilsson ◽

Tal M. Hörer

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Hemodynamic Instability ◽

Balloon Occlusion ◽

University Hospital ◽

Trauma Patients ◽

Single Center ◽

Hemorrhage Control ◽

Single Center Experience ◽

Low Profile

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

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Prehospital Hemorrhage Control and REBOA

Current Trauma Reports ◽

10.1007/s40719-019-00169-3 ◽

2019 ◽

Vol 5 (3) ◽

pp. 129-136 ◽

Cited By ~ 1

Author(s):

Eric M. Campion ◽

Charles J. Fox

Keyword(s):

Hemorrhage Control

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Dopamine-1 receptor stimulation impairs intestinal oxygen utilization during critical hypoperfusion

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00636.2002 ◽

2003 ◽

Vol 284 (2) ◽

pp. H668-H675 ◽

Cited By ~ 6

Author(s):

Jorge A. Guzman ◽

Ariosto E. Rosado ◽

James A. Kruse

Keyword(s):

Blood Flow ◽

Mucosal Blood Flow ◽

Control Group ◽

Oxygen Utilization ◽

Hemorrhage Control ◽

Receptor Stimulation ◽

Anesthetized Dogs ◽

Group 2 ◽

Increased Susceptibility ◽

Group 1

Effects of a dopamine-1 (DA-1) receptor agonist on systemic and intestinal oxygen delivery (D˙o 2)-uptake relationships were studied in anesthetized dogs during sequential hemorrhage. Control ( group 1) and experimental animals ( group 2) were treated similarly except for the addition of fenoldopam (1.0 μg · kg−1 · min−1) in group 2. Both groups had comparable systemic criticalD˙o 2(D˙o 2crit), but animals in group 2 had a higher gut D˙o 2crit(1.12 ± 1.13 vs. 0.80 ± 0.09 ml · kg−1 · min−1, P < 0.05). At the mucosal level, a clear biphasic delivery-uptake relationship was not observed in group 1; thus oxygen consumption by the mucosa may be supply dependent under physiological conditions. Group 2 demonstrated higher peak mucosal blood flow and lack of supply dependency at higher mucosalD˙o 2 levels. Fenoldopam resulted in a more conspicuous biphasic relationship at the mucosa and a rightward shift of overall splanchnic D˙o 2crit despite increased splanchnic blood flow. These findings suggest that DA-1 receptor stimulation results in increased gut perfusion heterogeneity and maldistribution of perfusion, resulting in increased susceptibility to ischemia.

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Multiple middle cerebral artery aneurysms in an infant

Journal of Neurosurgery ◽

10.3171/jns.1990.72.5.0806 ◽

1990 ◽

Vol 72 (5) ◽

pp. 806-809 ◽

Cited By ~ 14

Author(s):

Cornelia Cedzich ◽

J. Schramm ◽

G. Röckelein

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Systemic Disease ◽

Intracerebral Hematoma ◽

Left Middle Cerebral Artery ◽

Content Type ◽

Middle Cerebral Artery Aneurysms ◽

Subarachnoid Blood ◽

Left Middle ◽

Control Angiography

✓ An 11-month-old boy was admitted for evaluation of drowsiness, vomiting, and convulsions. Computerized tomography showed subarachnoid blood in the left sylvian fissure and a small intracerebral hematoma in the temporal lobe. Angiography revealed several aneurysms of the left middle cerebral artery (MCA). During surgery, 13 aneurysms were found arising from one main branch of the left MCA, and this segment of the MCA was trapped. Somatosensory evoked potentials did not show any change during surgery. The diseased arterial segment was examined histologically and the pathogenetic aspects of the case are discussed. Control angiography 6 months later excluded systemic disease or other aneurysms. The rarity of such lesions in childhood and their successful surgical treatment are discussed briefly.

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Preliminary Observations on the Need for Control Angiography after Peripheral Endovascular Brachytherapy Using a Centering Balloon

Journal of Endovascular Therapy ◽

10.1177/152660280200900219 ◽

2002 ◽

Vol 9 (2) ◽

pp. 241-245 ◽

Cited By ~ 2

Author(s):

Wolfgang J. Hofmann ◽

Michael Kopp ◽

Barbara Kofler ◽

Ara Ugurluoglu ◽

Dieter Kogelnik ◽

...

Keyword(s):

Endovascular Brachytherapy ◽

Control Angiography

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Quaternary Ammonium Groups Modified Starch Microspheres for Instant Hemorrhage Control

Colloids and Surfaces B Biointerfaces ◽

10.1016/j.colsurfb.2017.08.024 ◽

2017 ◽

Vol 159 ◽

pp. 937-944 ◽

Cited By ~ 20

Author(s):

Fangping Chen ◽

Xiaoyan Cao ◽

Junxia Yu ◽

Huantong Su ◽

Shuda Wei ◽

...

Keyword(s):

Quaternary Ammonium ◽

Modified Starch ◽

Hemorrhage Control

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Effect of gingival retraction cord and retraction paste on gingival tissue in fixed prosthodontics impression

Update Dental College Journal ◽

10.3329/updcj.v3i2.17995 ◽

2014 ◽

Vol 3 (2) ◽

pp. 20-27

Author(s):

Mohammad Shamsuzzaman ◽

Sheikh Md Shahriar Quader ◽

Shakila Fatema ◽

Md Abdul Gofur ◽

Khaleda Akter

Keyword(s):

The Other ◽

Gingival Tissue ◽

Hemorrhage Control ◽

Fixed Prosthodontics ◽

Abutment Teeth ◽

The Mean ◽

Mean Time ◽

Reduced Time

Background & Objectives: Of the various gingival retraction systems available in the market, a cordless paste system is fairly new entrant into this field. This system promises to provide an easier method to obtain optimum retraction with excellent hemorrhage control. The present study was designed to clinically evaluate the efficacy of paste retraction system and medicated retraction cords on the basis of relative easy of working, hemorrhage control and amount of vertical gingival retraction. Methods: 40 subjects were selected requiring full veneer restoration where more than one abutment teeth were to be prepared. After the preparation of the abutment teeth flexible scales were used to measure the sulcus depth before retraction and after retraction. Medicated retraction cord technique was used on one abutment tooth and on the other abutment tooth paste retraction system was employed. Subjectively easy of placement and hemorrhage scores was assessed. Results: The mean time taken for paste retraction technique was 45.13 seconds and for medicated retraction cord technique was 105.4 seconds. In all the subjects paste retraction technique was relatively easier as compared with medicated retraction cord technique. Mean hemorrhage scores using paste retraction technique was 0.05 and using medicated retraction cord technique it was 1.70. Mean vertical gingival retraction using paste retraction technique was .36mm and using medicated retraction cord technique was 0.54mm Conclusion: Within the limitations of this study, paste retraction system requires reduced time for application, is easier to place, and provides excellent hemorrhage control in comparison to medicated retraction cord. However, medicated retraction cord provides increased amount of vertical retraction as compared to paste retraction technique. DOI: http://dx.doi.org/10.3329/updcj.v3i2.17995 Update Dent. Coll. j: 2013; 3 (2): 20-27

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