| 1. |
- Manzano-Nunez, Ramiro, et al.
(författare)
-
Could resuscitative endovascular balloon occlusion of the aorta improve survival among severely injured patients with post-intubation hypotension?
- 2018
-
Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Berlin/Heidelberg. - 1863-9933 .- 1863-9941. ; 44:4, s. 527-533
-
Forskningsöversikt (refereegranskat)abstract
- Current literature shows the association of post-intubation hypotension and increased odds of mortality in critically ill non-trauma and trauma populations. However, there is a lack of research on potential interventions that can prevent or ameliorate the consequences of endotracheal intubation and thus improve the prognosis of trauma patients with post-intubation hypotension. This review paper hypothesizes that the deployment of REBOA among trauma patients with PIH, by its physiologic effects, will reduce the odds of mortality in this population. The objective of this paper is to review the current literature on REBOA and post-intubation hypotension, and, furthermore, to provide a rational hypothesis on the potential role of REBOA in severely injured patients with post-intubation hypotension.
|
|
| 2. |
- Brill, Jason B., et al.
(författare)
-
The Role of TEG and ROTEM in Damage Control Resuscitation
- 2021
-
Ingår i: Shock. - : LIPPINCOTT WILLIAMS & WILKINS. - 1073-2322 .- 1540-0514. ; 56:1S, s. 52-61
-
Tidskriftsartikel (refereegranskat)abstract
- Trauma-induced coagulopathy is associated with very high mortality, and hemorrhage remains the leading preventable cause of death after injury. Directed methods to combat coagulopathy and attain hemostasis are needed. The available literature regarding viscoelastic testing, including thrombelastography (TEG) and rotational thromboelastometry (ROTEM), was reviewed to provide clinically relevant guidance for emergency resuscitation. These tests predict massive transfusion and developing coagulopathy earlier than conventional coagulation testing, within 15 min using rapid testing. They can guide resuscitation after trauma, as well. TEG and ROTEM direct early transfusion of fresh frozen plasma when clinical gestalt has not activated a massive transfusion protocol. Reaction time and clotting time via these tests can also detect clinically significant levels of direct oral anticoagulants. Slowed clot kinetics suggest the need for transfusion of fibrinogen via concentrates or cryoprecipitate. Lowered clot strength can be corrected with platelets and fibrinogen. Finally, viscoelastic tests identify fibrinolysis, a finding associated with significantly increased mortality yet one that no conventional coagulation test can reliably detect. Using these parameters, guided resuscitation begins within minutes of a patients arrival. A growing body of evidence suggests this approach may improve survival while reducing volumes of blood products transfused.
|
|
| 3. |
- Duchesne, Juan, et al.
(författare)
-
Prehospital Mortality Due to Hemorrhagic Shock Remains High and Unchanged : A Summary of Current Civilian EMS Practices and New Military Changes
- 2021
-
Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 56:1S, s. 3-8
-
Tidskriftsartikel (refereegranskat)abstract
- Mortality secondary to trauma related hemorrhagic shock has not improved for several decades. Underlying the stall in progress is the conundrum of effective pre-hospital interventions for hemorrhage control. As we know, neither pressing hard on the gas nor "Stay and play" have changed mortality over the last 20 years. For this reason, when dealing with effective changes that will improve severe hemorrhage mortality outcomes, there is a need for the creation of a hybrid pre-hospital model.Improvements in mortality outcomes for patients with severe hemorrhage based on evidence for common civilian prehospital procedures such as in-field intubation and immediate fluid resuscitation with crystalloid solution is weak at best. The use of tourniquets, once considered too risky to use, however, has risen dramatically in large part due success seen during their use in the military. Their use in the civilian setting shows promising results. Recently updated military Advanced Resuscitative Care (ARC) guidelines propose the use of prehospital whole blood transfusion as well as in-field use of Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Several case studies from Europe suggest these strategies are feasible for use in the civilian population, but could they be implemented in the U.S.?
|
|
| 4. |
- Hörer, Tal M., 1971-, et al.
(författare)
-
Endovascular Resuscitation and Trauma Management (EVTM) : Practical Aspects and Implementation
- 2021
-
Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 56:1S, s. 37-41
-
Tidskriftsartikel (refereegranskat)abstract
- In recent years there has been a tremendous increase in hemorrhage control by endovascular methods. Traumatic and non-traumatic hemorrhage is being more frequently managed with endografts, embolization agents and minimal invasive methods. These methods initially were used in hemodynamically stable patients only, whereas now are being implemented in acute settings and hemodynamically unstable patients. The strategy of using endovascular and combined open-endo methods approach for hemodynamic instability in trauma and non-trauma patients has been named EVTM- EndoVascular resuscitation and Trauma Management. The EVTM concept will be presented in this article, describing how it is developed and used, as well as its limitations and future aspects.
|
|
| 5. |
- Kauvar, David, et al.
(författare)
-
Challenges and Opportunities for Endovascular Treatment of Hemorrhage in Combat Casualty Care
- 2021
-
Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 56:1S, s. 46-51
-
Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: The care of the hemorrhaging patient continues to evolve. The use of endovascular techniques to treat hemorrhage has increased significantly in civilian trauma care over the past 15 years and is identified as a major national trauma care research priority. Endovascular techniques are being increasingly employed to treat major thoracoabdominal arterial injuries and resuscitative endovascular balloon occlusion of the aorta is being adopted at trauma centers as a supportive adjunct to resuscitation in the exsanguinating patient. Emerging endovascular technology offers the opportunity to provide temporary or permanent control of non-compressible torso hemorrhage, which remains a vexing problem in combat casualty care. Endovascular advances have not been translated to the care of combat casualties to any significant degree, however. This review provides a summary and analysis of the gap between civilian endovascular hemorrhage control and combat casualty care practice to better align future research and development efforts.
|
|
| 6. |
- Kauvar, David, et al.
(författare)
-
Circulatory Trauma: A Paradigm for Understanding the Role of Endovascular Therapy in Hemorrhage Control
- 2021
-
Ingår i: Shock. - : LIPPINCOTT WILLIAMS & WILKINS. - 1073-2322 .- 1540-0514. ; 56:1S, s. 22-29
-
Tidskriftsartikel (refereegranskat)abstract
- The pathophysiology of traumatic hemorrhage is a phenomenon of vascular disruption and the symptom of bleeding represents one or more vascular injuries. In the Circulatory Trauma paradigm traumatic hemorrhage is viewed as injury to the circulatory system and suggests the underlying basis for endovascular hemorrhage control techniques. The question "Where is the patient bleeding?" is replaced by "Which blood vessels are disrupted?" and stopping bleeding becomes a matter of selective vessel access and vascular flow control. Control of traumatic hemorrhage has traditionally been performed via external access to the end organ that is bleeding followed by the application of direct pressure, packing, or clamping and repair of directly affected blood vessels. In the circulatory trauma paradigm, bleeding is seen as disruption to vessels which may be accessed internally, from within the vascular system. A variety of endovascular treatments such as balloon occlusion, embolization, or stent grafting can be used to control hemorrhage throughout the body. This narrative review presents a brief overview of the current role of endovascular therapy in the management of circulatory trauma. The authors draw on their personal experience combined with the last decade of published experiences with the use of endovascular techniques in trauma and present general recommendations for their evolving use. The focus of the review is on the use of endovascular techniques as specific vascular treatments using the circulatory trauma paradigm.
|
|
| 7. |
- McCoy, Christopher Cameron, et al.
(författare)
-
Back to the Future: Whole Blood Resuscitation of the Severely Injured Trauma Patient
- 2021
-
Ingår i: Shock. - : LIPPINCOTT WILLIAMS & WILKINS. - 1073-2322 .- 1540-0514. ; 56:1S
-
Tidskriftsartikel (refereegranskat)abstract
- Following advances in blood typing and storage, whole blood transfusion became available for the treatment of casualties during World War I. While substantially utilized during World War II and the Korean War, whole blood transfusion declined during the Vietnam War as civilian centers transitioned to blood component therapies. Little evidence supported this shift, and recent conflicts in Iraq and Afghanistan have renewed interest in military and civilian applications of whole blood transfusion. Within the past two decades, civilian trauma centers have begun to study transfusion protocols based upon cold-stored, low anti-A/B titer type O whole blood for the treatment of severely injured civilian trauma patients. Early data suggests equivalent or improved resuscitation and hemostatic markers with whole blood transfusion when compared to balanced blood component therapy. Additional studies are taking place to define the optimal way to utilize low-titer type O whole blood in both prehospital and trauma center resuscitation of bleeding patients.
|
|
| 8. |
- Ordonez, Carlos A., et al.
(författare)
-
The Colombian Experience in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) : The Progression From a Large Caliber to a Low-Profile Device at a Level I Trauma Center
- 2021
-
Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 56:1S, s. 42-45
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is now performed in many trauma centers, it is used at more than 250 hospitals in the United States and there is an increase rate of publications with the experience in these centers, but there is a gap of knowledge regarding the use of REBOA in Latin-America. This paper endeavors to describe the utilization of REBOA at a high level Latin-American Trauma Center and the transition from a large caliber to a low-profile device with the concomitant reduction in the groin access complications.Methods: A prospective, observational, single-center study was conducted. We included all trauma patients who underwent REBOA. We recorded data from admission parameters, complications, and clinical outcomes.Results: Fifty patients were included. Most of the REBOA catheters were inserted in the operating room [47 (94%)], and the arterial access was done by surgical cutdown [40 (80%)]. All the complications were associated with the catheter of 11 Fr Sheath used in 36 patients [n = 8/36 (22%) vs. n = 0/14 (0%); P = 0.05].Conclusion: REBOA can be used safely in blunt or penetrating thoracic, abdominal, and pelvic trauma. The insertion of a 7 Fr Sheath was associated with lower complications, so its use should be preferred over larger calibers.
|
|
| 9. |
- Roberts, Derek J., et al.
(författare)
-
Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Non-compressible Torso Hemorrhage
- 2020
-
Ingår i: JOURNAL OF ENDOVASCULAR RESUSCITATION AND TRAUMA MANAGEMENT. - : OREBRO UNIV HOSPITAL. - 2002-7567. ; 4:2, s. 109-119
-
Forskningsöversikt (refereegranskat)abstract
- Non-compressible torso hemorrhage (NCTH) (i.e. bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this article, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude by providing recommendations as to when each of these methods may be best, when indicated, to manage injured patients with NCTH.
|
|
| 10. |
- Tatum, Danielle, et al.
(författare)
-
Time to Hemorrhage Control in a Hybrid ER System : Is It Time to Change?
- 2021
-
Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 56:1S, s. 16-21
-
Tidskriftsartikel (refereegranskat)abstract
- Time to hemorrhage control is critical, as mortality in patients with severe hemorrhage that arrive to trauma centers with sign of life remains over 40%. Prompt identification and management of severe hemorrhage is paramount to reducing mortality. In traditional US trauma systems, the early hospital course of a severely hemorrhaging patient typically proceeds from the trauma resuscitation bay to the operating room or angiography suite with a potential stop for radiological imaging. This protracted journey can prove fatal as it consumes valuable minutes. In contrast to the current US system is a newly developed and increasingly adopted system in Japan called the hybrid emergency room system (HERS). The hybrid ER is equipped to allow resuscitation, imaging, and damage control intervention to occur in the ER without the need to transport the patient to a subsequent destination. The HERS is relatively new and remains restricted to a small number of institutions, limiting the ability to robustly examine impact(s) on patient outcomes. Even if proven to yield superior outcomes, there are significant obstacles to adopting the HERS in the US. Challenges such as the high cost of building and implementing a HER system, return on investment, and the significant differences between the US and Japan in terms of physician training, trauma center, and reimbursement schemes may render the hybrid ER system to be unfeasible in most current trauma centers. Barriers aside, the Japanese hybrid ER system remains the most novel recent advancement in the quest to reduce potentially preventable mortality from hemorrhage.
|
|
| 11. |
- Williams, James, et al.
(författare)
-
Limitations of Available Blood Products for Massive Transfusion During Mass Casualty Events at us Level 1 Trauma Centers
- 2021
-
Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 56:1S, s. 62-69
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Exsanguination remains a leading cause of preventable death in traumatically injured patients. To better treat hemorrhagic shock, hospitals have adopted massive transfusion protocols (MTPs) which accelerate the delivery of blood products to patients. There has been an increase in mass casualty events (MCE) worldwide over the past two decades. These events can overwhelm a responding hospital's supply of blood products. Using a computerized model, this study investigated the ability of US trauma centers (TCs) to meet the blood product requirements of MCEs.METHODS: Cross-sectional survey data of on-hand blood products were collected from 16 US level-1 TCs. A discrete event simulation model of a TC was developed based on historic data of blood product consumption during MCEs. Each hospital's blood bank was evaluated across increasingly more demanding MCEs using modern MTPs to guide resuscitation efforts in massive transfusion (MT) patients.RESULTS: A total of 9,000 simulations were performed on each TC's data. Under the least demanding MCE scenario, the median size MCE in which TCs failed to adequately meet blood product demand was 50 patients (IQR 20-90), considering platelets. 10 TCs exhaust their supply of platelets prior to RBCs or plasma. Disregarding platelets, five TCs exhausted their supply of O- packed red blood cells (RBCs), six exhausted their AB plasma supply, and five had a mixed exhaustion picture.CONCLUSION: Assuming a TC's ability to treat patients is limited only by their supply of blood products, US level-1 TCs lack the on-hand blood products required to adequately treat patients following a MCE. Use of non-traditional blood products, that have a longer shelf life, may allow TCs to better meet the blood product requirement needs of patients following larger MCEs.
|
|
