Availability of on-site acute vascular interventional radiology techniques performed by trained acute care specialists

Abstract

INTRODUCTIONComprehensive treatment of a patient in acute medicine and surgery requires the use of both surgical techniques and other treatment methods. Recently, acute vascular interventional radiology techniques (AVIRTs) have become increasingly popular, enabling adequately trained in-house experts to improve the quality of on-site care.METHODSAfter obtaining approval from our institutional ethics committee, we conducted a retrospective study of AVIRT procedures performed by acute care specialists trained in acute medicine and surgery over a 1-year period, including those conducted out of hours. Trained acute care specialists were required to be certified by the Japanese Association of Acute Medicine and to have completed at least 1 year of training as a member of the endovascular team in the radiology department of another university hospital. The study was designed to ensure that at least one of the physicians was available to perform AVIRT within 1 h of a request at any time. Femoral sheath insertion was usually performed by the resident physicians under the guidance of trained acute care specialists.RESULTSThe study sample comprised 77 endovascular procedures for therapeutic AVIRT (trauma, n = 29, and nontrauma, n = 48) among 62 patients (mean age, 64 years; range, 9–88 years), of which 55% were male. Of the procedures, 47% were performed out of hours (trauma, 52%; and nontrauma, 44%). Three patients underwent resuscitative endovascular balloon occlusion of the aorta in the emergency room. No major device-related complications were encountered, and the overall mortality rate within 60 days was 8%. The recorded causes of death included exsanguination (n = 2), pneumonia (n = 2), sepsis (n = 1), and brain death (n = 1).CONCLUSIONWhen performed by trained acute care specialists, AVIRT seems to be advantageous for acute on-site care and provides good technical success. Therefore, a standard training program should be established for acute care specialists or trauma surgeons to make these techniques a part of the standard regimen.LEVEL OF EVIDENCETherapy/care management study, level V.

High‐grade traumatic torso visceral injury with hemodynamic instability: effectiveness of transarterial embolization using n‐butyl cyanoacrylate

“…The main concern associated with DCIR is to maintain or re‐establish normal hemodynamics to contain the ongoing hemorrhage using minimally invasive interventional radiology (IR) as soon as possible. Our belief that acute vascular IR should be carried out by IR‐trained acute care specialists in acute trauma resuscitation with or without hemodynamic instability, and the details of treatment indications and protocols have been previously described . The concept of DCIR supports our belief, and we conduct training in the radiology department to practice handling these embolic agents, which may help to achieve successful hemostasis in future trauma resuscitation.…”

Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study

“… 26 We think that such competencies would be effectively performed using a hybrid operating room (HOR) or HER. Although there are some reports regarding acute care with IR performed by trained acute care specialists or acute care surgeons, 27 28 few studies have evaluated the effectiveness of similar trauma management protocols.…”

Achieving Multidisciplinary Collaboration for the Creation of a Pulmonary Embolism Response Team: Creating a “Team of Rivals”

“…This includes CDT, clot maceration, and newer techniques including aspiration thromboembolectomy. Interventional radiologists are often involved in the care of trauma [45][46][47] and acute stroke patients, [48][49][50] and are able to mobilize a team rapidly. In addition, the training in diagnostic radiology that interventional radiologists bring to a PERT can be invaluable during multidisciplinary calls.…”