Current opinion on catheter-based hemorrhage control in trauma patients

Holcomb, John B.; Fox, Erin E.; Scalea, Thomas M.; Napolitano, Lena M.; Albarado, Rondel; Gill, Brijesh S.; Dunkin, Brian J.; Kirkpatrick, Andrew W.; Cotton, Bryan A.; Inaba, Kenji; DuBose, Joseph J.; Cohen, Alan M.; Azizzadeh, Ali; Brenner, Megan; Cohen, Mitchell J.; Wade, Charles E.; Lumsden, Alan B.; Andrassy, Richard J.; Rhee, Peter; Bass, Barbara L.; Mattox, Kenneth L.; Britt, L. D.; Eastman, A. Brent; Hoyt, David B.; Rasmussen, Todd E.

doi:10.1097/ta.0000000000000133

Cited by 49 publications

(22 citation statements)

References 28 publications

(20 reference statements)

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“…Most of these injuries were resident within the liver (4), pelvis (3), or both (1). Vessels targeted for embolization included the main hepatic artery (2), left hepatic artery (1), right hepatic artery (1), portal vein (2), internal iliac arteries (3), and/or branches of the internal iliac arteries (2). Similarly, the 25 patients who were initially transferred to the angiography suite and then received a subsequent open procedure were defined by scenarios of ongoing hemorrhage from a different site and therefore continued hemodynamic instability (21 patients) or required an urgent repair of other organs/regions despite improved hemodynamics following embolization (4 patients: open fractures [2], peripheral vascular injuries [2], craniectomy/ craniotomy for traumatic brain injury and skull destruction [1]).…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3] Time critical decisions with regard to patient diagnoses, resuscitation strategies, and the use of techniques to arrest persistent bleeding remain based on clinical acumen, pattern recognition, and clinician experience. 4 Unfortunately, selecting the correct initial destination of choice (operating theater [OR], angiography suite, or intensive care unit [ICU]) can still be extremely difficult in some clinical scenarios.…”

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confidence: 99%

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The potential benefit of a hybrid operating environment among severely injured patients with persistent hemorrhage

Fehr

Beveridge

DʼAmours³

et al. 2016

Journal of Trauma and Acute Care Surgery

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

The potential benefit of a hybrid operating environment among severely injured patients with persistent hemorrhage

Fehr

Beveridge

DʼAmours³

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…Independent of ongoing hemorrhage, overcoming the consequences of ischemia-reperfusion can be challenging and result in hemodynamic collapse. Emerging clinical data on the use of REBOA reports successful 30-day survival following brief periods of aortic occlusion (20–40 minutes); however longer periods of aortic occlusion are associated with significantly increased morbidity and mortality (5, 13, 17, 26, 27). The inability of REBOA to extend the duration of occlusion beyond the time afforded by aortic cross-clamping has resulted in REBOA, like aortic cross-clamping, to be relegated to a salvage maneuver of last resort confined to only a few select trauma centers.…”

Section: Endovascular Methods For Achieving Aortic Occlusionmentioning

confidence: 99%

Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage

Russo

Neff

Johnson

et al. 2016

Shock

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Management of non-compressible torso hemorrhage (NCTH) remains a challenge despite continued advancements in trauma resuscitation. Resuscitative thoracotomy with aortic cross-clamping and recent advances in endovascular aortic occlusion, including resuscitative endovascular occlusion of the aorta (REBOA), have finite durations of therapy due to the inherent physiologic stressors that accompany complete occlusion. Here we attempt to illuminate the current state of aortic occlusion for trauma resuscitation including: 1) explanation of the deleterious consequences of complete occlusion, 2) potential methods and limitations of existing technology to overcome these consequences, 3) a description of innovative methods to improve the resuscitation of NCTH. By explaining the complexity and potential deleterious effects of resuscitation augmented with aortic occlusion, our goal is to provide practitioners with a real-world perspective on current endovascular technology and to encourage the continued innovation required to overcome existing obstacles.

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“…The advent of hybrid operating rooms where open and endovascular techniques can be utilized as needed has made possible the more frequent use of minimally invasive approaches for definitive control of NCTH in severely injured polytrauma patients. 13 However, both precise anatomic descriptions of the source(s) of NCTH and comparisons of endovascular versus open techniques for hemorrhage control are lacking. The objective of this study was two-fold: first, to describe the precise anatomic locations of bleeding in a population of adult trauma patients with NCTH, and second, to test the hypothesis that the endovascular (ENDO) versus open (OPEN) approach was associated with reduced mortality in trauma patients presenting with NCTH.…”

Section: Introductionmentioning

confidence: 99%

Multicenter retrospective study of noncompressible torso hemorrhage

Chang

Fox

Greene

et al. 2017

Journal of Trauma and Acute Care Surgery

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Objective Rational development of technology for rapid control of non-compressible torso hemorrhage (NCTH) requires detailed understanding of what is bleeding. Our objectives were to describe the anatomic location of truncal bleeding in patients presenting with NCTH and compare endovascular (ENDO) versus open (OPEN) management. Methods Retrospective study of adult trauma patients with NCTH admitted to 4 urban level 1 trauma centers in the Houston and San Antonio metropolitan areas in 2008–2012. Inclusion criteria: named axial torso vessel disruption, AIS chest or abdomen ≥3 with shock (base excess <−4) or truncal operation in ≤90 minutes, or pelvic fracture with ring disruption. Exclusion criteria: isolated hip fractures, falls from standing, or prehospital CPR. After dichotomizing into OPEN, ENDO, and resuscitative thoracotomy (RT) groups based on the initial approach to control NCTH, a mixed-effects Poisson regression with robust error variance (controlling for age, mechanism, ISS, shock, hypotension, and severe head injury as fixed effects and site as a random effect) was used to test the hypothesis that ENDO was associated with reduced in-hospital mortality in NCTH patients. Results 543 patients with NCTH underwent ENDO (n=166, 31%), OPEN (n=309, 57%), or RT (n=68, 12%). Anatomic bleeding locations were 25% chest, 41% abdomen, and 31% pelvis. ENDO was used to treat relatively few types of vascular injuries, while OPEN and RT injuries were more diverse. ENDO patients had more blunt trauma (95% vs 34% vs 32%); severe injuries (median ISS 34 vs 27 vs 21), and increased time to intervention (median 298 vs 92 vs 51 min), compared to OPEN and RT. Mortality was 15% vs 20% vs 79%. ENDO was associated with decreased mortality compared to OPEN (RR 0.58, 95% CI 0.46–0.73). Conclusion Although ENDO may reduce mortality in NCTH patients, significant group differences limit the generalizability of this finding. Level of Evidence Level V (Prognostic and Epidemiologic)

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Current opinion on catheter-based hemorrhage control in trauma patients

Cited by 49 publications

References 28 publications

The potential benefit of a hybrid operating environment among severely injured patients with persistent hemorrhage

The potential benefit of a hybrid operating environment among severely injured patients with persistent hemorrhage

Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage

Multicenter retrospective study of noncompressible torso hemorrhage

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