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.

Contemporary Utilization of Zone III REBOA for Temporary Control of Pelvic and Lower Junctional Hemorrhage Reliably Achieves Hemodynamic Stability in Severely Injured Patients

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Jason Pasley
Keyword(s):  
Vital Signs ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Acute Care Surgery ◽  
Level Of Evidence ◽  
Systemic Complications ◽  
Occlusion Balloon ◽  
Valuable Adjunct ◽  
Care Surgery ◽  
Temporary Control

Background: Aortic occlusion is a valuable adjunct for management of traumatic pelvic and lower extremity junctional hemorrhage. Methods: The American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry was reviewed for patients requiring Zone III resuscitative endovascular balloon occlusion of the aorta (REBOA) from eight verified trauma centers. After excluding patients in arrest, demographics, elements of treatment and outcomes were identified. Results: From Nov 2013 – Dec 2016, 30 patients had Zone III REBOA placed. Median age was 41.0 (IQR 38); median ISS 41.0 (IQR 12). Hypotension (SBP < 90mm Hg) was present on admission in 30.0% and tachycardia (HR > 100 bpm) in 66.7%. Before REBOA placement, vital signs changed in this cohort with hypotension in 83.3% and tachycardia noted in 90%. Median initial pH was 7.14 (IQR 0.22), and median admission lactate 9.9 mg/dL (IQR 5). Pelvic binders were utilized in 40%. Occlusion balloon devices included Coda™ (70%), ER-REBOA™ (13.3%), Reliant™ (10%).  After REBOA, hemodynamics improved in 96.7% and stability (BP consistently > 90 mm Hg) was achieved in 86.7%. Median duration of REBOA was 53.0 mins (IQR 112). Median PRBC and FFP requirements were 19.0 units (IQR (17) and 17.0 units (IQR 14), respectively. One amputation unrelated to REBOA utilization was required. Systemic complications included AKI (23.3%) and MODS (10%). REBOA specific complications included groin hematoma (3.3%) and distal thromboembolization (16.7%). Survival to discharge was 56.7%, with in-hospital deaths occurring in the ED 7.7%, OR 23.1%, ICU 69.2%. Conclusions: This review discusses the specifics of the contemporary use of Zone III REBOA placement as well as local and systemic complications for patients in extremis with pelvic/junctional hemorrhage. Further review is required determine optimal patient selection. Level of Evidence: Level IV Study Type: Therapeutic Key Words   Zone III REBOA, Pelvic Bleeding, Junctional Hemorrhage

scholarly journals Is the Whole Greater than the Sum of Its Parts? The Implementation and Outcomes of a Whole Blood Program in Ecuador

2021 ◽  
Author(s):  
Amber Nicole Himmler ◽  
Monica Eulalia Galarza Armijos ◽  
Jeovanni Reinoso Naranjo ◽  
Sandra Gioconda Peña Patiño ◽  
Doris Sarmiento Altamirano ◽  
...  
Keyword(s):  
Latin America ◽  
Hemorrhagic Shock ◽  
Whole Blood ◽  
Vital Signs ◽  
Human Albumin ◽  
Acute Care Surgery ◽  
Trauma Patients ◽  
Transfusion Reaction ◽  
Shock Index ◽  
Care Surgery

Abstract Background: Hemorrhagic shock is a major cause of mortality in low-and-middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood program in Latin America and to discuss the outcomes of the patients that received whole blood (WB).Methods: We conducted a retrospective review of patients resuscitated with WB from 2013-2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included: gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, Shock Index, Revised Trauma Score (RTS) in trauma patients, intraoperative crystalloid (lactated ringers or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length-of-stay and in-hospital mortality.Results: The sample includes a total of 101 patients, 57 of whom were trauma and acute care surgery (TACS) patients and 44 of whom were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. Average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of whole blood. Overall mortality was 14/101 (13.86%) in the first 24 hours and 6/101 (5.94%) after 24 hours.Conclusion: Implementing a WB protocol is achievable in LMICs. Whole blood allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a whole blood program implemented in a civilian hospital in Latin America.

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.

Establishing an Acute Care Surgery Service: Lessons Learned From the Epidemiology of Emergent Non-Trauma Patients and Increasing Utilization of Laparoscopy

2010 ◽  
Vol 69 (4) ◽  
pp. 938-942 ◽  
Author(s):  
Allison L. Speer ◽  
Helen J. Sohn ◽  
Ashkan Moazzez ◽  
Jason Portillo ◽  
Tatyan Clarke ◽  
...  
Keyword(s):  
Acute Care ◽  
Lessons Learned ◽  
Acute Care Surgery ◽  
Trauma Patients ◽  
Care Surgery

The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry

2016 ◽  
Vol 81 (3) ◽  
pp. 409-419 ◽  
Author(s):  
Joseph J. DuBose ◽  
Thomas M. Scalea ◽  
Megan Brenner ◽  
Dimitra Skiada ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Acute Care ◽  
Aortic Occlusion ◽  
Acute Care Surgery ◽  
Care Surgery
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