scholarly journals Scalpel or Sheath? Outcomes Comparison Between Pre-Peritoneal Pelvic Packing and Angioembolization for Definitive Hemorrhage Control After REBOA

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Megan Brenner ◽  
Laura Moore ◽  
Bishoy Zakhary ◽  
Alexander Schwed ◽  
Alexis Cralley ◽  
...  
Keyword(s):  
Injury Severity ◽  
High Volume ◽  
Complication Rates ◽  
Wound Infections ◽  
Blood Products ◽  
Hemorrhage Control ◽  
Pelvic Packing ◽  
Local Complication ◽  
Pelvic Hemorrhage

ABSTRACT Background: The role of angioembolization (AE) and pre-peritoneal pelvic packing (PPP) for pelvic hemorrhage control in the era of REBOA has not been well described. Our aim was to investigate outcomes of PPP and AE after REBOA. Methods: Patients who received aortic occlusion (AO) at Zone 3 (distal abdominal aorta) plus PPP and/or AE at 3 high-volume REBOA centers between February 2013 and December 2018 were identified. Outcomes were compared between 3 groups based on procedures performed: REBOA with PPP only (RPPP), REBOA with angioembolization only (RAE), and REBOA with PPP and AE (RPPPAE). Results: 58 patients underwent REBOA at Zone 3; 37 RPPP, 13 RAE, 8 RPPPAE. Mean age was 45±16 years, mean injury severity score (ISS) 35±13, mean SBP pre-AO was 71±19mmHg, and post-AO SBP was 110±34mmHg. In-hospital mortality was 28%, with the majority of deaths occurring in the intensive care unit (17%). Age, ISS, admission SBP, physiology on admission and at the time of AO, response to AO, admission hemoglobin, blood products transfused, and rate of local wound infections were not different between RPPP and RAE groups. Comparing RPPP to RAE groups, duration of AO was significantly lower in the RPPP group (45+34 vs 81+37 mins, p=0.012), while rates of AKI (14% vs 46%) and distal embolism (8% vs 31%) were higher in the RAE group (p=0.015, 0.04 respectively).There was no statistical difference in mortality between RPPP (22%) and RAE patients (39%), including on regression analysis controlling for duration of AO and ongoing CPR at the time of AO. Conclusion: Despite a longer duration of AO and higher rates of ongoing CPR at the time of AO in RAE patients, mortality rates are similar whether hemostasis is achieved after REBOA with pelvic packing or angioembolization. RPPP results in significantly lower systemic and local complication rates.

scholarly journals Pelvic angioembolization: how urgently needed?

2020 ◽  
Author(s):  
Giles Lawrence Devaney ◽  
Kate Louise King ◽  
Zsolt Janos Balogh
Keyword(s):  
Clinical Suspicion ◽  
Base Deficit ◽  
First Line ◽  
Hemorrhage Control ◽  
Pelvic Packing ◽  
Hemostatic Resuscitation ◽  
Pelvic Hemorrhage ◽  
Transfusion Requirements ◽  
Recorded Data ◽  
Level 1

Abstract Purpose Angioembolization (AE) has been questioned as first-line modality for hemorrhage control of pelvic fracture (PF)-associated bleeding due to its potential inconsistent timely availability. We aimed to describe the patterns of AE use with hemostatic resuscitation and hypothesized that time to AE improved during the study period. Methods A Level-1 trauma center’s prospective PF database was analyzed. All consecutive PFs referred to angiography between 01/01/2009 and 12/31/2018 were included. All suspected pelvic hemorrhage was managed with AE; pelvic packing was not performed. Demographics, injury/shock severity, 24-h transfusion data, time to AE and mortality were recorded. Data are presented as median (IQR). Results During the 10-year study period, 1270 PF patients were treated. Thirty-six (2.8%) [75% male, 49 (33;65) years, ISS 36 (24;43), base deficit 3.65 (5.9;0.6), transfusions 4(2;7)] had AE. The indication for AE was clinical suspicion (CS) of pelvic bleeding [CS 24(67%)] or arterial blush on CT [CT 12 (33%)]. Median time to AE was 141 min for CS, and 223 min for CT, with no change over the study period. Patients with CS had a higher ISS, worse base deficit, greater transfusion requirements and faster time to AE. Five patients (14%) died. There were no deaths attributed to exsanguination. Conclusions Time to AE did not improve. Patients referred from CT are physiologically different from CS and should be analyzed accordingly, with CS resulting in faster time to AE in sicker patients. Contemporary resuscitation challenges the need for hyperacute AE as no patients exsanguinated despite time to AE of more than 2 h.

scholarly journals Complication rates of thyroidectomy by an experienced, high-volume thyroid surgeon in a private hospital in Abu Dhabi, United Arab Emirates

2018 ◽  
Vol 11 (1) ◽  
pp. 17
Author(s):  
Zahoor Ahmad ◽  
Ammar Kutaiman ◽  
Youssef Hassan ◽  
Peshraw Amin ◽  
MohammadAmjad Khan
Keyword(s):  
United Arab Emirates ◽  
Private Hospital ◽  
High Volume ◽  
Abu Dhabi ◽  
Complication Rates

scholarly journals The role of cardiomyocyte apoptosis in mechanisms of ischemic myocardial remodeling

2008 ◽  
Vol 7 (3) ◽  
pp. 33-38
Author(s):  
A. P. Khlapov ◽  
Yu. Yu. Vechersky ◽  
N. V. Ryazantseva ◽  
V. V. Kalyuzhin ◽  
L. R. Mustafina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Coronary Arteries ◽  
High Volume ◽  
Cardiomyocyte Apoptosis ◽  
Atherosclerotic Disease ◽  
Myocardial Remodeling ◽  
Early Stages

Here the role of cardiomyocyte apoptosis in mechanisms of ischemic myocardial remodeling was investigated. The samples of left ventricle were obtained on 50 patients with the diagnosed atherosclerotic disease of coronary arteries and heart failure. Obtained data allow to approve about the maximal importance of cardiomyocyte apoptosis at an early stages of ischemic myocardial remodeling. The role of cardiomyocyte apoptosis was decreased at a high volume of left ventricle. The received results suggest about an importance of cardiomyocyte apoptosis as an marker of ischemic myocardial remodeling and heart failure.

scholarly journals Pre-hospital CPR and early REBOA in trauma patients - Results from the ABOTrauma Registry.

2020 ◽  
Author(s):  
Peter Hilbert-Carius ◽  
David T McGreevy ◽  
Fikri M. Abu-Zidan ◽  
Tal M. Hörer
Keyword(s):  
Survival Rate ◽  
Hospital Admission ◽  
Injury Severity ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Probability Of Survival ◽  
Traumatic Cardiac Arrest ◽  
Predicted Probability ◽  
Using Data

Abstract Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to hospital with ongoing CPR. Nine patients (35%) died within the first 24 hours, while seventeen patients (65%) survived post 24 hours. The survival rate to hospital discharge was 27% (n=7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p=0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. Survival rate in the 16 patients responding to REBOA was 37.5% (n=6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from median (range) 56.5 (0-147) to 90 (0-200) mmHg. Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated.

scholarly journals The role of Edge-Driven Convection in the generation of volcanism I: a 2D systematic study

2020 ◽  
Author(s):  
Antonio Manjón-Cabeza Córdoba ◽  
Maxim Ballmer
Keyword(s):  
Numerical Models ◽  
High Volume ◽  
Oceanic Lithosphere ◽  
Companion Paper ◽  
Small Scale ◽  
Continental Lithosphere ◽  
Transient Phenomenon ◽  
Mantle Viscosity ◽  
Wide Range

Abstract. The origin of intraplate volcanism is not explained by the plate tectonic theory, and several models have been put forward for explanation. One of these models involves Edge-Driven Convection (EDC), in which cold and thick continental lithosphere is juxtaposed to warm and thin oceanic lithosphere to trigger convective instability. To test whether EDC can produce long-lived high-volume magmatism, we run numerical models of EDC for a wide range of mantle properties and edge (i.e., the oceanic-continental transition) geometries. We find that the most important parameters that govern EDC are the rheological paramaters mantle viscosity η0 and activation energy Ea. However, even the maximum melting volumes found in our models are insufficient to account for island-building volcanism on old seafloor, such as at the Canary Islands and Cape Verde. Also, beneath old seafloor, localized EDC-related melting commonly transitions into widespread melting due to small-scale sublithospheric convection, inconsistent with the distribution of volcanism at these volcanic chains. In turn, EDC is a good candidate to sustain the formation of small seamounts on young seafloor, as it is a highly transient phenomenon that occurs in all our models soon after initiation. In a companion paper, we investigate the implications of interaction of EDC with mantle-plume activity.

scholarly journals A review of the use of blood and blood products in HIV-infected patients

2012 ◽  
Vol 13 (2) ◽  
Author(s):  
Karen van den Berg
Keyword(s):  
Transfusion Medicine ◽  
Blood Products ◽  
Ethical Considerations ◽  
Appropriate Use ◽  
Hiv Patients ◽  
Hiv Negative

Despite numerous publications on the appropriate use of blood and blood products, few specifically consider the role of transfusion in the management of HIV. This review is a synthesis of conditions encountered in the management of HIV-infected patients where the transfusion of blood or blood products may be indicated. A consistent message emerging from the review is that the principles of transfusion medicine do not differ between HIV-negative and -positive patients. The aim of the review is to provide clinicians with a practical and succinct overview of the haematological abnormalities and clinical circumstances most commonly encountered in the HIV setting, while focusing on the rational and appropriate use of blood and blood products for HIV patients. Important ethical considerations in dealing with both the collection and transfusion blood and blood products in the HIV era have also been addressed. S Afr J HIV Med 2012;13(2):87-103.

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