BackgroundConventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings.MethodsWe retrospectively reviewed 134 patients (May of 2012 to February of 2015) meeting Class I trauma activation. Outcome data was compared between two groups: patients prior to thrombelastography implementation (n = 87) and patients with thrombelastography guided trauma resuscitation (n = 47). Blood product usage was compared for three time periods: first 4 h, the next 20 h, and first 24 h.ResultsFor the first 24 h of treatment, patients with thrombelastography guided trauma resuscitation had lower packed red blood cells (p = 0.0022) and fresh frozen plasma (p = 0.0474), but higher jumbo pack platelets (p = 0.0476) utilization when compared to the patients prior to thrombelastography implementation. There was no statistical significant difference in the utilization of crystalloids for any of the three time intervals. Patients with thrombelastography guided trauma resuscitation had a shorter hospital length of stay (p = 0.0011) and intensive care unit length of stay (p = 0.0059) than the patients prior to thrombelastography implementation. Cost savings in blood products transfusion were most pronounced in patients with penetrating injuries.DiscussionUsing visco-elastic tests to guide blood transfusion was first used for liver transplant patients and then applied to cardiovascular surgery and trauma. Similar to other studies, this study showed using visco-elastic tests for trauma patietns corresponded to an overall reduction in the use of packed red blood cells and fresh frozen plasma during the first 24 hours of resuscitation. In addition, this study showed using visco-elastic tests corresponded to a significant reduction in both hospital and intensive care unit length of stay.ConclusionThis study demonstrates that Thrombelastography guided trauma resuscitation decreases the overall transfusion requirements of packed red blood cells and fresh frozen plasma. However, given the nature of under-recognized jumbo pack platelets dysfunction in the conventional laboratory parameters, jumbo pack platelets utilization is higher when following Thrombelastography directed resuscitation. The utilization of Thrombelastography corresponded to a reduction in hospital length of stay, intensive care unit length of stay and cost of transfused blood products.Electronic supplementary materialThe online version of this article (10.1186/s13049-017-0443-4) contains supplementary material, which is available to authorized users.
This study demonstrates that PCIS remains a suitable, less invasive first-line therapy for iliac artery occlusions. PCIS has lower morbidity, shorter hospital length of stay, and equivalent secondary patency but inferior primary patency compared with ABF.
sion (78%), diabetes (47%), hyperlipidemia (50%), coronary artery disease (25%), congestive heart failure (12%), chronic obstructive pulmonary disease (8%), hemodialysis dependence (15%) and active tobacco use (27%). Use of several medications increased after bypass: aspirin (51% to 66%), statins (53% to 62%), beta blockers (37% to 50%). Clopidogrel use was unchanged after bypass (33%). Mean follow up was 342 days (range 3-1591 days). At two-years, cumulative graft patency was 67%, limb salvage was 67%, and survival was 81%. Aspirin usage increased secondary graft patency from 46% to 83% (P ϭ .005) and 51% to 73% (P Ͻ .05), respectively. Usage of clopidogrel or beta-blocker did not have a statistically significant effect on patency. Statin usage increased secondary graft patency from 59% to 73% (P Ͻ .03).Conclusion: Medications commonly prescribed for atherosclerosis such as aspirin and statins demonstrated patency benefit in patients undergoing infrainguinal bypass in a population with predominantly critical limb ischemia. Introduction:The mechanical environment and properties of the carotid artery play an important role in the formation and progression of atherosclerosis in the carotid bifurcation. The purpose of this work was to measure and compare the range and variation of circumferential stress and tangent elastic moduli in the human common (CCA), external (ECA) and internal (ICA) carotid arteries over the cardiac cycle in vivo.Methods: Measurements were performed in the surgically exposed proximal cervical CCA, distal ECA and distal ICA of normotensive patients (n ϭ 16) undergoing carotid endarterectomy. All measurements were completed over the cardiac cycle in the repaired bifurcation. B-mode Duplex ultrasonography and semi-automatic segmentation algorithm were used to track changes in the arterial diameter and wall thickness in response to pressure measured concurrently with an angiocatheter placed in the CCA. These measurements were then used to calculate the variation of circumferential stresses, tangent elastic moduli, and dynamic stiffness of the arterial wall.Results: The diameter and wall thickness of CCA, ECA and ICA were found to decrease and dynamic stiffness to increase from proximal CCA to distal ECA and ICA. The circumferential stress from end-diastole to peaksystole varied nonlinearly from 25Ϯ7 to 63 Ϯ 23 kPa (CCA), from 22 Ϯ 7 to 57 Ϯ 19 kPa (ECA) and from 28 Ϯ 8 to 67 Ϯ 23 kPa (ICA). Tangent elastic moduli also varied nonlinearly as follows: from 0.40 Ϯ 0.25 to 1.50 Ϯ 2.05 MPa (CCA), from 0.49Ϯ0.34 to 1.14 Ϯ 0.52 MPa (ECA) and from 0.68 Ϯ 0.31 to 1.51 Ϯ 0.69 MPa (ICA). The dynamic stiffness of CCA and ECA increased more than 3-fold and the dynamic stiffness of ICA increased more than 2.5-fold at peak-systole compared to end-diastole.Conclusions: The in vivo mechanical behavior of CCA, ECA and ICA was qualitatively similar, but quantitatively different. All three arteries exhibited nonlinear variations of circumferential stress and tangent elastic moduli within the normal pressure range. Th...
Objectives:To examine clinical and anatomic factors associated with cerebral ischemia requiring shunt placement during carotid endarterectomy (CEA) performed in awake patients.Methods: Between 2003 and 2009, 592 CEAs were performed under cervical block anesthesia with shunt placement in patients developing cerebral ischemic findings. Risk factors assessed included; severity of carotid disease, presence of preoperative ipsilateral neurological symptoms and comorbidities. Stump pressure index (SPI) was calculated by dividing mean stump pressure by mean common carotid artery pressure.Results: Of 592 CEAs, 54 (9.1%) required shunt placement. Preoperative neurological symptoms (TIA and stroke) were similar in both shunt (31.4%) and nonshunt (23.4%) groups. Hypertension, diabetes, coronary artery disease, or nicotine abuse were not significant predictors of shunt placement.Conclusions: Cerebral ischemia following carotid clamping cannot be predicted by clinical presentation or severity of carotid stenosis. The majority of patients with low SPI (Ͻ0.3) will require shunt.
Background: Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings.
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