scholarly journals Damage Control Surgery for Thoracic Outlet Vascular Injuries: The New Resuscitative Median Sternotomy Plus Endovascular Aortic Balloon Occlusion of the Aorta Approach

2021 ◽  
Vol 52 (2) ◽  
pp. e4054611
Author(s):  
Michael Parra ◽  
Carlos Alberto Ordoñez ◽  
Luis Fernando Pino ◽  
Mauricio Millan ◽  
Yaset Caicedo ◽  
...  
Keyword(s):  
Damage Control ◽  
Head Injuries ◽  
Median Sternotomy ◽  
Surgical Care ◽  
Damage Control Surgery ◽  
Organ Damage ◽  
Balloon Occlusion ◽  
Vascular Injuries ◽  
Early Application ◽  
Aortic Balloon Occlusion

Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% of these die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. The aim of this article is to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with Zone I resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification.

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in a Multidisciplinary Approach

2017 ◽  
Vol 12 (4) ◽  
pp. e1-e2 ◽  
Author(s):  
Carolina Nilsson ◽  
Linda Bilos ◽  
Tal Hörer ◽  
Artai Pirouzram
Keyword(s):  
Multidisciplinary Approach ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Definitive Treatment ◽  
Bleeding Management ◽  
Aortic Balloon Occlusion ◽  
Trauma Case ◽  
Management Concept ◽  
Endovascular Balloon Occlusion

The usage of resuscitative endovascular balloon occlusion of the aorta, also known as aortic balloon occlusion, is an emerging method for bleeding control as a bridge to definitive treatment in trauma management. We describe a trauma case where resuscitative endovascular balloon occlusion of the aorta was used as part of the EndoVascular hybrid Trauma and bleeding Management concept to facilitate transient hemorrhage control and thereby to permit damage control surgery. The case is an illustration of the adoption of a multidisciplinary approach.

Introduction to the Sixth Edition of the JEVTM

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Igor M. Samokhvalov
Keyword(s):  
Post Partum ◽  
Damage Control ◽  
Interdisciplinary Approach ◽  
Simulation Models ◽  
Balloon Occlusion ◽  
Aortic Aneurysms ◽  
Sixth Edition ◽  
Bleeding Management ◽  
Aortic Balloon Occlusion ◽  
Poster Presentations

Dear Readers, Welcome to the sixth edition of the JEVTM! In 1866, the Great Russian surgeon and scientist Nikolai Pirogov wrote: “A new era for surgery will begin, if we can quickly and surely control the flow in a major artery without exploration and ligation”. This era has now arrived and it is called EVTM! Our mission has been to maximize the benefits of endovascular technologies for trauma and bleeding patients: from the first attempts of REBOA by Carl Hughes in the 1950s with hand-made aortic balloon occlusion catheters used in our department since the early 1990s to modern successful cases of out-of-hospital REBOA use in combat and civilian casualties for ruptured aneurysms, post-partum hemorrhage and trauma. In this edition, you will find articles related to a new strategy of damage control interventional radiology (DCIR), partial REBOA in elderly patients and in ruptured aortic aneurysms, thrombolysis for trauma-associated IVC thrombosis, simulation models for training of REBOA, contemporary utilization of Zone III REBOA and more. As a continuation of EVTM development, Russian surgeons, emergency physicians, anesthetists, and others will be involved in the world of EVTM, participating in expanding the horizons of trauma care and cultivating the endovascular mindset. Also published in this edition are some of the abstracts that will be presented at the EVTM conference in Russia, St. Petersburg (7/06/2019). More than 35 oral and 30 poster presentations will make this conference a scientific feast for our audience! By adopting these new techniques for bleeding management, we are following Pirogov’s motto – to achieve fast endovascular hemorrhage control – which can only be done as part of an interdisciplinary approach.   We look forward to seeing you in Saint Petersburg at the EVTM-Russia meeting! www.evtm.org

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an adjunct to damage control surgery for combat trauma

2017 ◽  
Vol 1 (1) ◽  
pp. 58-62
Author(s):  
Jacob J Glaser ◽  
William Teeter ◽  
Travis Gerlach ◽  
Nathanial Fernandez
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Combat Trauma ◽  
Operating Table ◽  
Vascular Control ◽  
Resuscitative Thoracotomy ◽  
Combat Casualty ◽  
Transfusion Requirements ◽  
Endovascular Balloon Occlusion

Background: Non compressible torso hemorrhage continues to be the leading cause of preventable death in combat operations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an alternative hemorrhage control strategy, with morbidity advantages over resuscitative thoracotomy. We report the first ever use of REBOA in a combat casualty in Afghanistan. Case Report: An 18 year old Afghan male was injured by a single high velocity gunshot wound during partnered operations. He was treated with a damage control operation at the role 2 level, with significant presacral and pelvic bleeding controlled with combat gauze packing. The patient continued to be hemodynamically labile, with ongoing transfusion requirements and required emergent re-exploration.  Upon transfer from the gurney to the operating table the patient was noted to be hypotensive with a blood pressure of 62/38. An ER-REBOA catheter was measured for Zone 1 occlusion and placed without difficulty. The patient’s hemodynamics normalized, which allowed for sterile entry into the abdomen and vascular control. After 10 minutes of occlusion the balloon was deflated. Surgical repair was completed and patient survived to discharge. Conclusions:  REBOA is an adjunct to hemorrhagic shock that provides temporary proximal control bridge to definitive surgical hemostasis while avoiding the morbidity of a resuscitative thoracotomy. This case represents the first reported use of REBOA in the Afghanistan Theater. This case further supports increased consideration for use of REBOA in the forward setting.

Trauma

2020 ◽  
pp. 197-228
Author(s):  
Sarah Hodges ◽  
Sanja Janjanin ◽  
Judith Kendell ◽  
Nur Lubis ◽  
David Nott ◽  
...  
Keyword(s):  
Road Traffic ◽  
Damage Control ◽  
Head Injuries ◽  
Damage Control Surgery ◽  
Armed Conflicts ◽  
Difficult Patient ◽  
Middle Income ◽  
Middle Income Countries ◽  
High Resource ◽  
Resource Limited

In low- and middle-income countries, trauma, often from road traffic collisions, is one of the leading causes of morbidity and mortality. The approach to treating trauma in resource limited settings can be quite different to that in high-resource settings, requiring a lot of improvisation. The concepts of damage control surgery and resuscitation are covered, as are considerations for difficult patient groups such as head injuries, burns, and spinal injuries. The injury patterns seen as a result of armed conflicts (gun shots, blast injuries) will be unfamiliar to most anaesthetists and are also addressed in the chapter.

scholarly journals Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel

2020 ◽  
Author(s):  
Henri de Lesquen ◽  
Marie Bergez ◽  
Antoine Vuong ◽  
Alexandre Boufime-Jonqheere ◽  
Nicolas de l’Escalopier
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Large Scale ◽  
Damage Control ◽  
Surgical Care ◽  
Damage Control Surgery ◽  
Surgical Team ◽  
Golden Hour ◽  
Surgical Teams

Abstract Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.

scholarly journals REBOA at Role 2 Afloat: resuscitative endovascular balloon occlusion of the aorta as a bridge to damage control surgery in the military maritime setting

2017 ◽  
Vol 164 (2) ◽  
pp. 72-76 ◽  
Author(s):  
Paul Rees ◽  
B Waller ◽  
A M Buckley ◽  
C Doran ◽  
S Bland ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Operating Table ◽  
Royal Navy ◽  
Future Directions ◽  
Haemorrhage Control ◽  
Aviation Operations ◽  
The Military ◽  
Endovascular Balloon Occlusion

Role 2 Afloat provides a damage control resuscitation and surgery facility in support of maritime, littoral and aviation operations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers a rapid, effective solution to exsanguinating haemorrhage from pelvic and non-compressible torso haemorrhage. It should be considered when the patient presents in a peri-arrest state, if surgery is likely to be delayed, or where the single operating table is occupied by another case. This paper will outline the data in support of endovascular haemorrhage control, describe the technique and explore how REBOA could be delivered using equipment currently available in the Royal Navy Role 2 Afloat equipment module. Also discussed are potential future directions in endovascular resuscitation.

The management of pancreatic injuries

Trauma ◽  
2017 ◽  
Vol 19 (4) ◽  
pp. 243-253 ◽  
Author(s):  
JEJ Krige ◽  
E Jonas ◽  
SR Thomson ◽  
SJ Beningfield
Keyword(s):  
Damage Control ◽  
Head Injuries ◽  
Pancreatic Head ◽  
Damage Control Surgery ◽  
Pancreatic Injury ◽  
Multiple Organ ◽  
External Drainage ◽  
Pancreatic Injuries ◽  
Considerable Morbidity ◽  
Pancreatic Complications

Pancreatic injuries are relatively uncommon, but considerable morbidity and mortality may result if associated vascular and duodenal injuries are present or if the extent of the injury is underestimated and appropriate intervention is delayed. Optimal management includes the need for early diagnosis and accurate definition of the site and extent of injury. Prognosis is influenced by the cause and complexity of the pancreatic injury, the amount of blood lost, duration of shock, the rapidity of resuscitation and the quality and appropriateness of surgical intervention. Early mortality results from uncontrolled or major bleeding due to associated injuries while late mortality is generally a consequence of infection or multiple organ failure. Initial management of pancreatic trauma is similar to that of any patient with a severe abdominal injury. Stable patients with a suspected pancreatic injury should have non-invasive imaging including a CT scan or MRI. Urgent laparotomy is required in patients with evidence of major intraperitoneal bleeding, associated visceral trauma, or peritonitis. Operative intervention is guided by the integrity of the main pancreatic duct. External drainage is adequate for parenchymal injuries with an intact duct, while duct injuries of the neck, body and tail require a distal pancreatectomy. Pancreatic head injuries are more complex. If the duodenum is reparable and the ampulla is intact, external drainage suffices. Rarely, complex injuries may require a pancreatoduodenectomy after damage control surgery if the patient has multiple injuries and is unstable. Postoperative pancreatic complications including fistula and pseudocysts are common but can usually be treated endoscopically.

scholarly journals REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
Fernando Rodriguez ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
New Technology ◽  
Management Strategies ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Hemostatic Resuscitation ◽  
The Right ◽  
Trauma Surgeons

Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.

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