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

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.

Download Full-text

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.

Download Full-text

HEMATOLOGICAL PARAMETERS AND BODY COMPOSITION OF SOCCER PLAYERS

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220182403171040 ◽

2018 ◽

Vol 24 (3) ◽

pp. 202-205 ◽

Cited By ~ 1

Author(s):

Allana Kelly Bussollaro ◽

Barbara Nara de Freitas ◽

Raíssa Maria Fadel ◽

Gabriela Siqueira Lara ◽

Priscila Dabaghi Barbosa ◽

...

Keyword(s):

Body Composition ◽

Serum Iron ◽

Binding Capacity ◽

Hematological Parameters ◽

Soccer Players ◽

Mean Corpuscular Hemoglobin ◽

Corpuscular Hemoglobin ◽

Level Of Evidence ◽

Hematological Changes ◽

Post Hoc

ABSTRACT Introduction: Soccer players may experience hematological changes that could be detrimental to their health status. In addition, inadequate body composition may impair performance. Objective: To assess body composition and hematological changes over a year in soccer players. Methods: A retrospective observational study was conducted. Age, weight, height, body composition, blood count, serum iron, serum ferritin, serum transferrin and total iron binding capacity data were collected from the athletes’ medical records in the months of January, May and August of 2015 and January of 2016. Body mass index was also calculated. For the statistical analyses, the Anova and post-hoc Tukey’s post-hoc tests were used for the quantitative variables and the Chi-square test for the qualitative variables. The significance level adopted was p<0.05. Results: Data were evaluated for 51 athletes with a mean age of 23.53 ± 3.11 years, 77.10 ± 6.56 kg, 1.80 ± 0.07 and 15.6 ± 2.89% body fat (BF). We observed significant (p<0.05) changes in mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, cell size and eosinophils during the period evaluated. Among the athletes, 21.6% had decreased hematocrit levels and 3.9% had hemoglobin levels below the reference range. A BF% greater than 16% was significantly related to serum iron depletion (p = 0.01). Conclusion: Small significant hematological changes during the competitive year were observed, but without significant changes in body composition. Level of Evidence III; Study of nonconsecutive patients; without consistently applied reference ‘‘gold’’ standard.

Download Full-text

Abstract 16745: It Would be Possible to Rescue Traumatic Hemorrhagic Shock Patients Who Failed to Fluid Resuscitation (Fluid Non-responder) but Succeed in REBOA Resuscitation (REBOA/IABO Responder)

Circulation ◽

10.1161/circ.132.suppl_3.16745 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Tomohiko Orita ◽

Tomohiro Funabiki ◽

Motoyasu Yamazaki ◽

Masayuki Shimizu ◽

Tomohiro Sato ◽

...

Keyword(s):

Survival Rate ◽

Hemorrhagic Shock ◽

Fluid Resuscitation ◽

Recovery Rate ◽

Balloon Occlusion ◽

Shock State ◽

Occlusion Time ◽

Aortic Balloon Occlusion ◽

Significant Difference ◽

Traumatic Hemorrhagic Shock

Introduction: Fluid resuscitation (FR) and massive transfusion protocol (MTP) are important initial strategies for traumatic hemorrhagic shock cases. But poor responded patients to them are difficult to rescue. In such cases, open aortic cross clamping or intra-aortic balloon occlusion (IABO) would be performed as a temporary hemostasis treatment. Recently, IABO for severe trauma has been named resuscitative endovascular balloon occlusion of the aorta (REBOA). But it is still unclear which case can be rescued with REBOA. So we studied the relationship between the responsiveness to FR and REBOA. Methods: Consecutive 46 traumatic hemorrhagic shock patients underwent REBOA at our ER for last 86 months were included. All of their FAST were positive and done FR and MTP as a first-line resuscitation. 10Fr or 7Fr IABO devices were inserted at supraphrenic level (zone I) and underwent fundamental hemostasis by operative management (OM) and/or transcatheter arterial embolization (TAE). They were sorted into responded group or non-responded group for REBOA. The primary end point was a recovery rate from the shock state within 48 hours. Secondary end points were a survival rate in 30th days and a rate of complications. Results: 26 transient or non-responded patients (Fluid Non-responder) responded for REBOA (REBOA Responder group). 20 Fluid Non-responders did not respond for REBOA (REBOA Non-responder group). There were no significant differences in ISS (REBOA Responder vs. Non-responder: 45.8+/-15.2 vs. 54.8+/-22.3), amount of total fluid (7187+/-5782ml vs. 6772+/-4851) and total blood transfusion (4816+/-3006ml vs. 5080+/-3330), required time to occlude after arriving ER (25.3+/-12.6min vs. 19.4+/-9.8) and total occlusion time (76.4+/-66.5min vs. 92.7+/-34.4). There was significant difference in the changes of systolic blood pressure before and after of REBOA (59.3+/-25.7mmHg vs. 38.3+/-39.4, p=0.04). A recovery rate from shock state was 65%(12/26) vs. 0%(0/20) (p<0.01) and a survival rate was 14/26(54%) vs. 0/20(0%) (p<0.01). One complication occurred in REBOA Responder group but was not lethal. Conclusions: It would be necessary to recognize that Fluid Non-responder but REBOA Responder with traumatic hemorrhagic shock could be possible to rescue.

Download Full-text

Increased Incidence of Injury Among Runners With COVID-19

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211061144 ◽

2021 ◽

pp. 194173812110611

Author(s):

Brett G. Toresdahl ◽

James N. Robinson ◽

Stephanie A. Kliethermes ◽

Jordan D. Metzl ◽

Sameer Dixit ◽

...

Keyword(s):

New York ◽

Cross Sectional Study ◽

Multiple Organ ◽

Medical Professional ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Direct Role ◽

Cross Sectional ◽

Electronic Survey ◽

Organ Systems

Background: Coronavirus disease 2019 (COVID-19) affects multiple organ systems. Whether and how COVID-19 affects the musculoskeletal system remains unknown. We aim to assess the association between COVID-19 and risk of injury. Hypothesis: Runners who report having COVID-19 also report a higher incidence of injury. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: An electronic survey was distributed from July through September 2020, by New York Road Runners, ASICS North America, race medical directors, and through social media. Inclusion criteria were runners 18 years or older who had participated in ≥1 race (running or triathlon) in 2019. Results: A total of 1947 runners participated and met inclusion criteria. Average age was 45.0 (SD, 12.2) years and 56.5% were women. A total of 123 (6.3%) runners self-reported having COVID-19; 100 (81%) reported their diagnosis was from a laboratory test (polymerase chain reaction or antibody) and 23 reported being diagnosed by a medical professional without confirmatory laboratory testing. Since March 2020, 427 (21.9%) reported an injury that prevented running for at least 1 week, including 38 of 123 (30.9%) who self-reported having COVID-19 and 389 of 1435 (21.3%) who did not report having COVID-19 ( P = 0.01). After adjusting for age, sex, the number of races in 2019, and running patterns before March 2020, runners who self-reported a diagnosis of COVID-19 had a higher incidence of injury compared with those who did not (odds ratio, 1.66; 95% CI, 1.11-2.48; P = 0.01). Conclusion: Injuries were more often self-reported by runners with laboratory-confirmed or clinically diagnosed COVID-19 compared with those who did not report COVID-19. Given the limitations of the study, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear. Clinical Relevance: Direct and indirect musculoskeletal sequelae of COVID-19 should be further investigated, including the risk of exercise- and sports-related injury after COVID-19.

Download Full-text

World trauma education: hemorrhage control training for healthcare providers in India

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000263 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000263 ◽

Cited By ~ 3

Author(s):

Lindsay Andrea Smith ◽

Sarah Caughey ◽

Susan Liu ◽

Cassandra Villegas ◽

Mohan Kilaru ◽

...

Keyword(s):

Healthcare Providers ◽

Trauma Patients ◽

Bleeding Control ◽

Cross Sectional Survey ◽

Hemorrhage Control ◽

Level Of Evidence ◽

Cross Sectional ◽

Life Saving ◽

Poor Outcomes ◽

Trauma Education

BackgroundHemorrhage remains a major cause of death around the world. Eighty percent of trauma patients in India do not receive medical care within the first hour. The etiology of these poor outcomes is multifactorial. We describe findings from the first Stop the Bleed (StB) course recently offered to a group of medical providers in southern India.MethodsA cross-sectional survey of 101 participants who attended StB trainings in India was performed. Pre-training and post-training questionnaires were collected from each participant. In total, 88 healthcare providers’ responses were analyzed. Three bleeding control skills were presented: wound compression, wound packing, and tourniquet application.ResultsAmong participants, only 23.9% had received prior bleeding control training. Participants who reported feeling ‘extremely confident’ responding to an emergency medical situation rose from 68.2% prior to StB training to 94.3% post-training. Regarding hemorrhage control abilities, 37.5% felt extremely confident before the training, compared with 95.5% after the training. For wound packing and tourniquet application, 44.3% and 53.4%, respectively, felt extremely confident pre-training, followed by 97.7% for both skills post-training. Importantly, 90.9% of StB trainees felt comfortable teaching newly acquired hemorrhage control skills. A significant majority of participants said that confidence in their wound packing and tourniquet skills would improve with more realistic mannequins.ConclusionTo our knowledge, this is the first StB training in India. Disparities in access to care, long transport times, and insufficient numbers of prehospital personnel contribute to its significant trauma burden. Dissemination of these critical life-saving skills into this region and the resulting civilian interventions will increase the number of trauma patients who survive long enough to reach a trauma center. Additionally, considerations should be given to translating the course into local languages to increase program reach.Level of EvidenceLevel IV.

Download Full-text

Introduction and evaluation of the ACS BCon basic course in Zaragoza, Spain

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000227 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000227

Author(s):

Carlos Yanez ◽

Antonio Güemes ◽

Ana Navarro ◽

Jacqueline Vazquez ◽

Alberto Moreno

Keyword(s):

Medical Students ◽

University Hospital ◽

Hemorrhage Control ◽

Level Of Evidence ◽

Significance Level ◽

American College Of Surgeons ◽

The Usa ◽

Basic Course ◽

The University ◽

Healthcare Employees

BackgroundThe American College of Surgeons Bleeding Control Basic (BCon) course aimed at teaching hemorrhage control techniques in the USA had not yet been taught in Spain. The purpose of this study is to assess its implementation among students and healthcare employees in the Lozano Blesa University Hospital of Zaragoza, a middle-sized Spanish city.MethodsThe study was conducted in a University Hospital and at the University of Zaragoza, scheduling four free B-Con sessions from 2017 to 2018. Two groups were identified as forming the population: healthcare employees and medical students. An anonymous questionnaire was completed at the end of the course regarding content, applicability, usefulness, relevance, and satisfaction. Study variables were ranked from 0 to 10: poor (when graded from 0 to 3), fair (4 to 6) and good (7 to 10). Results were compared between the groups, expressed in percentages and χ2 tested to analyze significant differences if any.ResultsAmong the 83 individuals who completed the course, 46 were medical students and 37 healthcare employees; 61% women and 39% men; aged 21 years to 52 years. Attendees evaluated satisfaction with the highest grade (84%), followed by usefulness (73%), applicability (70%), and relevance (66%). There was no variable graded as poor. The comparison of perceptions between groups did not reveal statistical differences based on a 0.05 significance level.ConclusionWe concluded that the B-Con course was valued as good for relevance, usefulness, applicability, and satisfaction by the majority of the studied population.Level of evidenceLevel III.

Download Full-text