scholarly journals Is Your Trauma Center Peds Ready?

2022 ◽  
Vol 48 (1) ◽  
pp. 2-6
Author(s):  
Elizabeth L. Stone
Keyword(s):  
Author(s):  
Valentina Chiarini

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.


Author(s):  
Jacob J Glaser ◽  
Adam Czerwinski ◽  
Ashley Alley ◽  
Michael Keyes ◽  
Valentino Piacentino ◽  
...  

Background: REBOA has become an established adjunct to hemorrhage control. Prospective data sets are being collected, primarily from large, high volume trauma centers. There are limited data, and guidelines, to guide implementation and use outside of highly resourced environments. Smaller centers interested in adopting a REBOA program could benefit from closing this knowledge gap. Methods: A clinical series of cases utilizing REBOA from Grand Strand Medical Center, Myrtle Beach, South Carolina were reviewed. This represents early data from a busy community trauma center (ACS Level 2), from January 2017 to May 2018. Seven cases are identified and reported on, including outcomes. Considerations and ‘lessons learned’ from this early institutional experience are commented on.   Results: REBOA was performed by trauma and acute care surgeons for hemorrhage and shock (blunt trauma n=3, penetrating trauma n=2, no- trauma n=2). All were placed in Zone 1 (one initially was placed in zone 3 then advanced). Mean (SD) systolic pressure (mmHg) before REBOA was 43 (30); post REBOA pressure was 104 (19). N=4 were placed via an open approach, n=3 percutaneous (n=2 with ultrasound). All with arrest before placement expired (n=3) and all others survived. Complications are described.   Conclusions: REBOA can be a feasible adjunct for shock treatment in the community hospital environment, with outcomes comparable to large centers, and can be implemented by acute care and trauma surgeons. A rigorous process improvement program and critical appraisal process are critical in maximizing benefit in these centers.


2020 ◽  
Vol 37 ◽  
pp. 163-197
Author(s):  
Youngeun Jin ◽  
Myunghee Kim
Keyword(s):  

2010 ◽  
Vol 175 (5) ◽  
pp. 317-323 ◽  
Author(s):  
Heather C. Yun ◽  
Lorne H. Blackbourne ◽  
John A. Jones ◽  
John B. Holcomb ◽  
Duane R. Hospenthal ◽  
...  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
E. Berkeveld ◽  
Z. Popal ◽  
P. Schober ◽  
W. P. Zuidema ◽  
F. W. Bloemers ◽  
...  

Abstract Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.


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