Increased Trauma Center Volume Is Associated with Improved Survival in Trauma Patients Undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta: Data from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery

2020 ◽  
Vol 231 (4) ◽  
pp. S320
Author(s):  
Claudia P. Orlas ◽  
Joseph Jeremy DuBose ◽  
Megan Brenner ◽  
Luis Saldarriaga ◽  
Fernando Rodriguez ◽  
...  
Keyword(s):  
Acute Care ◽  
Trauma Center ◽  
American Association ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Acute Care Surgery ◽  
Trauma Patients ◽  
Center Volume ◽  
Care Surgery ◽  
Endovascular Balloon Occlusion

Validation of a Novel Clinical Criteria to Predict Candidacy for Aortic Occlusion: An Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Study

2020 ◽  
Vol 86 (10) ◽  
pp. 1418-1423
Author(s):  
Reynold Henry ◽  
Kazuhide Matsushima ◽  
Rachel N. Henry ◽  
Gregory A. Magee ◽  
Christoper P. Foran ◽  
...  
Keyword(s):  
Acute Care ◽  
Vital Signs ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Acute Care Surgery ◽  
Trauma Patients ◽  
Clinical Criteria ◽  
Resuscitative Thoracotomy ◽  
Control Procedures ◽  
Care Surgery

For trauma patients with noncompressible truncal hemorrhage (NCTH), aortic occlusion (AO) is attempted with either resuscitative thoracotomy (RT) or the resuscitative endovascular balloon occlusion of the aorta (REBOA). However, it is often challenging to identify the group of patients who would benefit from AO procedures. We hypothesized that patients who met simple clinical criteria would have better outcomes following AO procedures. This is a retrospective cohort study using the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database (November 2013-August 2019) which included patients who arrived with signs of life and underwent AO procedures (RT or zone 1 REBOA). Outcomes were compared between patients who met the criteria (admission vital signs: Glasgow Coma Scale (GCS) ≥9 and systolic blood pressure <90 mm Hg) and those who did not. Subgroup analyses were then conducted on patients who had a REBOA placed and those who underwent RT. A total of 998 patients met our inclusion criteria. Of those, a REBOA was placed in 364 patients (37%), while 634 (64%) underwent RT. The overall mortality rate in the criteria (+) group was significantly lower than that in the criteria (−) group (62 vs. 79%, P < .001). In patients who survived beyond the emergency department following AO procedures, those who met the criteria underwent hemorrhage control procedures more frequently (83% vs. 57%, P < .001). Our data suggest that simple clinical criteria could guide the provider for proceeding with AO in patients with suspected NCTH.

scholarly journals Development of an Extended Acute Care Surgery Service in Response to the Covid-19 Global Pandemic: Assessment of Clinical Patient Outcomes and Staff Psychological Well-being

2020 ◽  
Author(s):  
Sachin Mathur ◽  
Chung Fai Jeremy Ng ◽  
Fangju Koh ◽  
Mingzhe Cai ◽  
Gautham Palaniappan ◽  
...  
Keyword(s):  
Acute Care ◽  
Elective Surgery ◽  
Well Being ◽  
Acute Care Surgery ◽  
Trauma Patients ◽  
Model Of Care ◽  
Psychological Well Being ◽  
Unique Challenge ◽  
Clinical Patient ◽  
Care Surgery

Abstract BackgroundAs the COVID-19 pandemic sweeps across the world, healthcare departments must adapt to meet the challenges of service provision and staff/patient protection. Unlike elective surgery, Acute care surgery (ACS) workloads cannot be artificially reduced providing a unique challenge for administrators to balance healthcare resources between the COVID-19 surge and regular patient admissions. MethodsAn extended ACS (eACS) model of care is described with the aim of limiting COVID-19 healthcare worker and patient cross-infection as well as providing 24/7 management of emergency general surgical (GS) and trauma patients. The eACS service comprised 5 independent teams covering a rolling 1:5 24-hr call. Attempts to completely separate eACS teams and patients from the elective side were made. The service was compared to the existing ACS service in terms of clinical and efficiency outcomes. Finally, a survey of staff attitudes towards these changes, concerns regarding COVID-19 and psychological well-being was assessed.ResultsThere were no staff/patient COVID-19 cross-infections. Compared to the ACS service, eACS patients had reduced overall length of stay (2-days), time spent in the Emergency Room (46 minutes) and time from surgery to discharge (2.4-hours). Mortality was decreased during this time. The eACS model of care saved financial resources and bed-days for the organisation. The changes were well received by team-members who also felt that their safety was prioritised.ConclusionIn healthcare systems affected by COVID-19, an eACS model may assist in preserving psychological well-being for healthcare staff whilst providing 24/7 care for emergency GS and trauma patients.

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