Severe liver injury with traumatic cardiac arrest successfully treated by damage control surgery and transcatheter arterial embolization in the hybrid operating room: a case report

Abstract Background The damage control approach is known to reduce the mortality rate in severely injured patients and has now become a common practice. Transcatheter arterial embolization (TAE) has been shown to be useful with combining with damage control laparotomy in identifying and controlling active arterial hemorrhage. Hybrid operating room (OR) allows both damaged control surgery and TAE in the same location in minimal time. We report a case of a patient with three cardiac arrests who was saved by early intervention using damage control surgery (DCS) with interventional radiology (IVR) in the hybrid OR. Case presentation A 46-year-old woman was injured in a collision with a tree while snowboarding. She was eventually transported to hybrid operating room in our hospital with the diagnosis of significant liver laceration and hemorrhagic shock. Damage control surgery was performed with perihepatic packing (PHP) and TAE was conducted to stop active bleeding from right hepatic artery. She experienced 3 times of cardiopulmonary arrest, which was successfully resuscitated on each occasion. Although she had total of 3 times of laparotomy but tolerated well. She was discharged on day 82 of hospitalization and showed no neurological sequelae. Conclusion Saving the life of a patient with severe trauma requires a multidisciplinary approach with cooperation and early information sharing among trauma team members. Sharing treatment strategy with the trauma team and early intervention using DCS with IVR in the hybrid operating room could save the patient’s life.

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Training Operating Room Teams in Damage Control Surgery for Trauma: A Followup Study of the Norwegian Model

Yearbook of Surgery ◽

10.1016/s0090-3671(08)79160-2 ◽

2008 ◽

Vol 2008 ◽

pp. 30-31

Author(s):

D.W. Mozingo

Keyword(s):

Operating Room ◽

Damage Control ◽

Damage Control Surgery ◽

Operating Room Teams

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Successful treatment of placenta previa totalis using the combination of a two-stage cesarean operation and uterine arteries embolization in a hybrid operating room

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2015-0072 ◽

2016 ◽

Vol 5 (1) ◽

pp. 31-34

Author(s):

Maya Koyano ◽

Junichi Hasegawa ◽

Tatsuya Arakaki ◽

Ryu Matsuoka ◽

Akihiko Sekizawa

Keyword(s):

Cesarean Section ◽

Operating Room ◽

Placenta Previa ◽

Transvaginal Ultrasound ◽

Arterial Embolization ◽

Lower Uterine Segment ◽

Hybrid Operating Room ◽

Operation Room ◽

Hybrid Operation ◽

Emergency Cesarean

Abstract A 37-year-old primigravida female with placenta previa totalis was transferred to our hospital at 29 weeks of gestation. A transvaginal ultrasound examination showed a dropped placenta into the uterine cervix and an effaced lower uterine segment. The boundary between the cervical muscle layer and the placenta was unclear. Consequently, although it was unclear whether complication of the adherence of placenta was present or not, massive hemorrhage with atonic bleeding in the lower uterine segment after placenta removal was strongly suspected. As the patient had uncontrolled vaginal bleeding, an emergency cesarean section was performed in a hybrid operating room. A transverse fundal incision of the uterus was made, and a 1143 g healthy neonate was delivered. As no signs of placental detachment or persistent bleeding were found, the uterus was closed, leaving the placenta. Thereafter bilateral uterine arterial embolization (UAE) with absorbable gelatin sponges was performed. On the third day after the operation, a second operation for placental removal. The placenta detached smoothly, but compression sutures were placed to control the bleeding at the site of placental removal around the uterine isthmus. In this case, we were able to conduct the treatment smoothly because of the antenatal ultrasound assessment and precise preparation of the cesarean section with UAE in the hybrid operation room. Using the hybrid operation room, sharing detailed surgical planning in cooperation with the physicians from other departments is important for obtaining a good outcome.

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Training Operating Room Teams in Damage Control Surgery for Trauma: A Followup Study of the Norwegian Model

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2007.06.015 ◽

2007 ◽

Vol 205 (5) ◽

pp. 712-716 ◽

Cited By ~ 12

Author(s):

Kari S. Hansen ◽

Per E. Uggen ◽

Guttorm Brattebø ◽

Torben Wisborg

Keyword(s):

Operating Room ◽

Damage Control ◽

Damage Control Surgery ◽

Operating Room Teams

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Damage control surgery: Our experience

Acta chirurgica iugoslavica ◽

10.2298/aci1004069l ◽

2010 ◽

Vol 57 (4) ◽

pp. 69-73

Author(s):

Zeljko Lausevic ◽

Vladimir Resanovic ◽

Goran Vukovic ◽

Aleksandar Karamarkovic ◽

Dejan Radenkovic ◽

...

Keyword(s):

Operating Room ◽

Damage Control ◽

Damage Control Surgery ◽

Trauma Patients ◽

Emergency Center ◽

Medical Facilities ◽

The World ◽

Injured Patients ◽

Uncontrolled Bleeding

Damage control surgery represents widely implemented technique of treatment of seriously injured patients all over the world. In medical facilities with large number of seriously injured patients, type of injuries often imposes method of damage control surgery as ultimate way in treating such patients. In Emergency center from 2005-2009. 895 patients had been operated because of the trauma to the abdomen and thorax. Method of damage control surgery had been implanted on 41 patients (4.6% of all operated patients). 18 patients died, and 30 seriously injured patients that hadn?t been treated according to this method had died in operating room. Likewise, 11 non-trauma patients were treated according to the principles of damage control surgery because of uncontrolled bleeding. The greatest challenge today is defining criteria for choosing right patients for damage control surgery.

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Cesena experience in the management of trauma induced coagulopathy: where are we going?

Reviews in Health Care ◽

10.7175/rhc.v4i3s.876 ◽

2013 ◽

Vol 4 (3S) ◽

pp. 5-16

Author(s):

Vanessa Agostini

Keyword(s):

Trauma Center ◽

Point Of Care ◽

Damage Control ◽

Fixed Ratio ◽

Damage Control Surgery ◽

Trauma Team ◽

Transfusion Medicine ◽

Blood Components ◽

Trauma Induced Coagulopathy ◽

Leading Position

In recent years the management of the Trauma Center has witnessed the implementation of a significant change in the approach to critical bleeding and acute trauma-induced coagulopathy. The Trauma Center of “Bufalini” Hospital in Cesena has achieved a leading position in this system, especially with a multidisciplinary approach that has strongly influenced the organization of the Trauma Center. Thus, it is of particular interest the involvement of specialists in Transfusion Medicine within the Trauma Center: “Bufalini” Hospital was among the first in Italy to bring hematologists from Transfusion Medicine Department in the Trauma Team. This approach, which has led to very significant improvements in the way we manage polytrauma patients, is now spreading widely in other national centers. In 2009 the first Massive Transfusion Protocol (MTP) was implemented in the Trauma Center, with the aim of identifying patients at risk, improving the communication between different healthcare professionals and achieving a blood components fixed ratio. Transfusion support was part of the context of the Damage Control Resuscitation (DCR) based on the principles of permissive hypotension, Damage Control Surgery (DCS) and Haemostatic Resuscitation. Considering the major medical and scientific knowledge and new data available, in 2011 the “Bufalini” Hospital Working Group modified its MTP with the aim of obtaining a rapid diagnosis of hyperfibrinolisis, an early diagnosis of hypofibrinogenemia and reduce therapy with blood components. It has also been developed an algorithm for the proper interpretation of Point-Of-Care Device results (ROTEM®).

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