Impact of Specific Emergency Measures on Survival in Out-of-Hospital Traumatic Cardiac Arrest

Introduction: The management of out-of-hospital traumatic cardiac arrest (TCA) for professional rescuers entails Advanced Life Support (ALS) with specific actions to treat the potential reversible causes of the arrest: hypovolemia, hypoxemia, tension pneumothorax (TPx), and tamponade. The aim of this study was to assess the impact of specific rescue measures on short-term outcomes in the context of resuscitating patients with a TCA. Methods: This retrospective study concerns all TCA patients treated in two emergency medical units, which are part of the Northern French Alps Emergency Network (RENAU), from January 2004 through December 2017. Utstein variables and specific rescue measures in TCA were compiled: fluid expansion, pelvic stabilization, tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at Day 30 with good neurological status (Cerebral Performance Category [CPC] score CPC 1 and CPC 2). Results: In total, 287 resuscitation attempts in TCA were included and 279 specific interventions were identified: 262 fluid expansions, 41 pelvic stabilizations, five tourniquets, and 175 bilateral thoracostomies (including 44 with TPx). Conclusion: Among the standard resuscitation measures to treat the reversible causes of cardiac arrest, this study found that bilateral thoracostomy and tourniquet application on a limb hemorrhage improve survival in TCA. A larger sample for pelvic stabilization is needed.

Effect of Mat Pilates on Body Fluid Composition, Pelvic Stabilization, and Muscle Damage during Pregnancy

In this study, according to the exercise intensity (50–60% of HRmax (Maximum Heart Rate), RPE (Rating of Perceived Exertion: 11–13) proposed by The American Congress of Obstetricians and Gynecologists (ACOG) for pregnant women, mat Pilates exercise is related to body composition, lipid parameters, and pelvic stabilization. The effects on muscle and muscle damage were investigated. The subjects of this study were 16 pregnant women registered at the Cultural Center of Gyeonggi-do C Women’s Hospital, and the gestation period was 16 to 24 weeks. The mat Pilates exercise program (twice a week, 60 min per day, total 12 weeks) changed the Pilates exercise program every 6 weeks according to the subject’s pain level and physical fitness. Body composition before and after exercise, hip flexion, abduction and dilated lipids, inflammation, muscle damage, and stress hormones were measured through blood biochemical analysis. First, the difference in total body water, intracellular water, and skeletal muscle changes (post-pre) increased significantly in the Pilates exercise (PE) group compared to the control (CON) group, while the extracellular/intracellular water ratio significantly decreased. The effect of Pilates on body composition and lipid profile confirmed that, after testing, total body water (TBW), intracellular water (ICW), and extracellular water (ECW) were significantly greater than pre-test values in both groups (TBW: z = −2.286, p = 0.022, r = 0.572; ICW: z = −2.818, p = 0.005, r = 0.705; ECW: z = −1.232, p = 0.218, r = 0.308), whereas the ECW/ICW ratio decreased significantly only in the PE group (z = −2.170, p = 0.030, r = 0.543); while the increases in TBW and ICW were greater in the PE group than in the CON group, the ECW/ICW ratio decreased significantly in the PE group. Blood tests showed significant increases in body weight (BW), body fat mass (BFM), and percentage of body fat (PBF) in both groups post-test as compared to pre-test (BW: z = −1.590, p = 0.112, r = 0.398; BFM: z = −0.106, p = 0.916; PBF: z = −1.643, p = 0.100, r = 0.411). There was a slight increase in creatine kinase (CK) and lactate dehydrogenase (LDH), which are indices of muscle damage, and in the difference between the periods within the group, the CK and LDH of the CON group showed a tendency to increase significantly after inspection compared to the previous values (CK: z = −1.700, p = 0.089, r = 0.425, LDH: z = −2.603, p = 0.009, r = 0.651). Aspartate aminotransferase (AST) decreased significantly in the Pilates exercise group compared to that in the control group, and as a result of confirming the difference in the amount of change in C-reactive protein (CRP), there was no significant difference between the two groups, and the PE group showed a tendency to decrease after inspection compared to the previous period even in the difference between the periods in the group. The CON group showed an increasing trend, but no significant difference was found. Cortisol, a stress hormone, also increased significantly after inspection both groups compared to before (CON group: z = −2.201, p = 0.028; PE group: z = −2.547, p = 0.011). Therefore, the 12 week Pilates exercise program conducted in this study has a positive effect on body water balance and strengthens the muscles related to pelvic stabilization within the range of reducing muscle damage or causing muscle damage and stress in pregnant women. We think that it has an effective exercise intensity.

Secondary Angio-Embolization After Emergent Pelvic Stabilization and Pelvic Packing Is a Safe Option for Patients With Persistent Hemorrhage From Unstable Pelvic Ring Injuries

Introduction: In patients with severe pelvic ring injuries, exsanguination still is the leading cause of death in the early post-injury phase. While mechanical pelvic ring stabilization and pre-peritoneal pelvic packing are mainly addressing venous bleeding, angio-embolization aims to control arterial bleeding. The goal of the present study was to evaluate the rate of postoperative angio-embolization after mechanical pelvic ring injury stabilization and pre-peritoneal pelvic packing. Bleeding sources detected in the angiography and the patient's outcome were investigated.Patients and Methods: Retrospective observational cohort study at a single academic level I trauma center, reviewing all patients with pelvic ring injuries admitted from 01/2010 to 12/2019. Patients with emergent mechanical pelvic ring stabilization (supraacetabular external fixator and/or pelvic C-clamp) and direct pre-peritoneal pelvic packing were further analyzed. Patients that underwent postoperative angio-embolization were compared with those that did not. All postoperative angio-embolizations were evaluated with regards to bleeding sources and type of embolization.Results: During the study period, a total of 39 patients required immediate mechanical pelvic stabilization and direct pre-peritoneal pelvic packing. Of these, 12 patients (30.8%) underwent a postoperative angio-embolization. The following vessels were identified as bleeding sources: superior gluteal artery (n = 6), obturator artery (n = 2), internal pudendal artery (n = 2), unnamed branches of the internal iliac artery (n = 3). A selective embolization was successful in 11 patients; in 1 patient, an unilateral complete occlusion of the internal iliac artery was performed to control the bleeding. Mean time from hospital admission to the surgical procedure was 52.8 ± 14.7 min and the mean time from admission to angio-embolization was 189.1 ± 55.5 min. The in-hospital mortality rate of patients with angio-embolization was 25.0% (n = 3). Of these, 2 patients died due to multiple organ failure and 1 patient due to severe head injury.Conclusion: Secondary angio-embolization after external pelvic fixation and pre-peritoneal pelvic packing was effective in controlling ongoing bleeding. The most frequently detected bleeding vessel was the superior gluteal artery, which is difficult to surgically address, further highlighting the importance of angio-embolization in the management algorithm.

Impact of specific emergency measures on survival of out of hospital traumatic cardiac arrest: data from the northern french alps cardiac arrest registry.

The management of Out of hospital Traumatic Cardiac Arrest (TCA) for professional rescuers combines advanced life support with specifics actions to treat potential reversible causes of the arrest: hypovolemia, hypoxemia, Tension Pneumothorax (TPx) and tamponade. The aim of this study was to assess the impact of specific rescue gestures on short-term outcomes in the context of resuscitation of patients with a pre-hospital TCA.Methods: We conducted a retrospective study of all TCA treated in two emergency medical units (EM unit), which are part of the Northern Alps emergency network, from January 2004 to December 2017. Utstein variables and specific rescue actions in TCA were compiled: advanced airway management, fluid administration, pelvic stabilization or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary end point was the survival rate at day 30 with good neurologic outcome (cerebral performance category [CPC] score 1 & 2).Results: 287 resuscitations attempt in TCA were included and 279 specific interventions were Identified: 262 Fluid expansion, 41 External Pelvic stabilizations, 5 tourniquets, 175 bilateral thoracostomies, (including 44 with TPx).Conclusion: Among standard resuscitation measures to treat reversible causes of cardiac arrest, we were able to show that bilateral thoracostomy and tourniquet application on a limb hemorrhage improves survival of TCA. A larger sample for pelvic stabilization is necessary.

Insights into the lower torso in late Miocene hominoidOreopithecus bambolii

Oreopithecus bambolii(8.3–6.7 million years old) is the latest known hominoid from Europe, dating to approximately the divergence time of thePan-hominin lineages. Despite being the most complete nonhominin hominoid in the fossil record, theO. bamboliiskeleton IGF 11778 has been, for decades, at the center of intense debate regarding the species’ locomotor behavior, phylogenetic position, insular paleoenvironment, and utility as a model for early hominin anatomy. Here we investigate features of the IGF 11778 pelvis and lumbar region based on torso preparations and supplemented by otherO. bamboliimaterial. We correct several crucial interpretations relating to the IGF 11778 anterior inferior iliac spine and lumbar vertebrae structure and identifications. We find that features of the early homininArdipithecus ramidustorso that are argued to have permitted both lordosis and pelvic stabilization during upright walking are not present inO. bambolii. However,O. bamboliialso lacks the complete reorganization for torso stiffness seen in extant great apes (i.e., living members of the Hominidae), and is more similar to large hylobatids in certain aspects of torso form. We discuss the major implications of theO. bamboliilower torso anatomy and howO. bamboliiinforms scenarios of hominoid evolution.

Bladder Exstrophy

Bladder exstrophy is a rare condition in which there is an error in fetal development leaving the bladder and pelvic structure malformed. The bladder, pelvic girdle, and external genitalia are often split, requiring repair. The goals of this repair are to improve quality of life in terms of urinary continence, aesthetics, pelvic stabilization, and sexual function. This repair often requires prolonged traction and external fixation to adequately fuse the pelvic girdle. To aid in the healing and tolerance of this, a prolonged epidural catheter is often used. The pharmokinetics and risk of infection are major considerations during the prolonged use of a caudal catheter.

Experience of application of extraperitoneal pelvic packing in unstable pelvic ring injuries

OBJECTIVE. Clinical efficacy of extraperitoneal pelvic packing for hemostasis was assessed in patients with unstable pelvic ring injuries and signs of unstable hemodynamics. MATERIAL AND METHODS. The results of treatment were analyzed in 19 patients with hemodynamically unstable pelvic ring injuries. Extraperitoneal pelvic packing was applied in order to stop bleeding after mechanical pelvic stabilization. The evaluation of hemostasis efficacy was performed by using computerized helical tomography with intravenous contrast. RESULTS. The extraperitoneal pelvic packing allowed doctors to achieve stop of bleeding in 14 (73,7 %) patients. CONCLUSIONS. Complex of mechanical stabilization and extraperitoneal pelvic packing of damaged pelvic ring could be actively used in cases of severe injuries for victims in critical conditions.