Emergency angio-embolisation in the operating theatre for trauma patients using the C-Arm digital subtraction angiography

Teo, Li Tserng; Punamiya, Sundeep; Chai, C; Go, Karen T. S.; Yeo, Y.T.; Wong, Daniel; Appasamy, Vijayan; Chiu, Ming Terk

doi:10.1016/j.injury.2011.01.026

Cited by 12 publications

(3 citation statements)

References 7 publications

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“…Finally, costly pharmacological adjuncts such as recombinant factor VIIa [27, 28] were not available. The role of angio-embolisation in arresting ongoing hemorrhage in trauma patients is relatively new [29]. None of our patients underwent angio-embolisation as part of initial trauma resuscitation/damage contol surgery.…”

Section: Discussionmentioning

confidence: 99%

Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Kisat

Zafar

Hashmi

et al. 2016

International Journal of Surgery

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Introduction Damage control surgery (DCS) is an established option for managing severely injured trauma patients. However, its role in the management of similar patients in the developing world is debatable. The purpose of this study is to describe characteristics and outcomes of patients undergoing DCS. Methods All trauma patients requiring laparotomies from 1996–2011 at a tertiary care hospital in South Asia were reviewed. DCS was defined in a patient who underwent a truncated laparotomy where the fascia was primarily left open, with the intention of physiological optimization in the Intensive Care Unit, followed by definitive surgery. The primary outcome was in-hospital mortality. Multivariate logistic regression was used to determine the independent predictors of mortality after adjustment for potential confounders. Results Of 258 patients, 47 underwent DCS. 40% patients were transferred from other hospitals. The time between injury and operation was 152 minutes (IQR: 90–330). Intra-operative laboratory parameters revealed a median pH of 7.16 (IQR: 7.10–7.27), median temperature of 34.7 (IQR: 34.0–35.4) and median PT of 15.9 (IQR: 12.4–21.2). 55% of the patients survived to discharge from hospital. Of those who died, 86% died before the first take back operation. Packed red blood cell transfusion and vascular injury were independently associated with mortality. Discussion Damage control surgery is feasible in developing countries, with more than 50% survival reported at one hospital. Future research should focus on critical care management. Conclusion Damage Control trauma laparotomy is feasible in tertiary care hospitals with multidisciplinary trauma teams in lesser-developed countries.

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Section: Discussionmentioning

confidence: 99%

Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Kisat

Zafar

Hashmi

et al. 2016

International Journal of Surgery

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“…This pioneer suite was equipped with a ceiling mounted single-planar angiography, coupled with a hybrid surgical operating table, and integrated with an operating room integration system [34]. Other hybrid operating rooms used for trauma management were operating rooms equipped with a digital subtraction angiography device [24,[35][36][37][38]. One study included in this review, reported results of trauma patients' management in an angiography suite equipped with a spiral CT [25].…”

Section: Resultsmentioning

confidence: 99%

Hybrid Trauma Management: Is It the Way We Are Heading?

Paran¹,

Kessel²

2020

JEVTM

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Background: Hybrid trauma management, namely, the combination of open and endovascular techniques and/or the application of endovascular methods in the OR/ER is a quickly growing concept worldwide. However, its implications are not well established. We aimed to review the current data regarding hybrid trauma management in medical literature. Methods: A review of the medical literature published between 2000 and 2020 using PubMed and OVID Medline databases was performed in search for clinical studies regarding hybrid trauma treatments. Case reports were excluded from this review. The manuscripts were analyzed regarding the mechanism, location and type of injury, endovascular and surgical techniques utilized and outcomes. Results: Fourteen studies reporting hybrid trauma management of a total of 1049 patients met the inclusion criteria and were analyzed. Blunt trauma was the leading trauma mechanism (87.13%) and the most common procedure was transcatheter arterial embolization (TAE), performed in 29.74% of patients. The overall mortality was 15.16%. Regarding case control studies, 85.71% have shown hybrid trauma management to be associated with a shorter time from arrival to intervention, 42.86% reported lower rates of unfavorable outcome 28.57% reported reduced requirement for red blood cell transfusion as compared with conventional management. Conclusions: This review did not find strong evidence supporting hybrid trauma management as a standard care. However, accumulating data suggests that hybrid management may be associated with a shorter time from arrival to intervention, lower rates of unfavorable outcome and reduced requirement for red blood cell transfusion as compared with conventional management of trauma patients.

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“…Angioembolization can be safely performed in the operating room where other interventions are also possible and avoids the potential delay from transport to or from the radiology suite [61]. Specialized hybrid operating rooms are being designed to accommodate the multidisciplinary treatme nt s t rate gie s fo r t r aum a p atie nts [62 • • ], but angioembolization using a portable C-arm is safe and effective [63]. In hemodynamically unstable patients with evidence of both intraperitoneal and pelvic fracture-related hemorrhage, our practice is to place a pelvic binder and proceed emergently to our hybrid operating room (see Fig.…”

Section: Concomitant Intraperitoneal Hemorrhagementioning

confidence: 99%

Angioembolization: Indications, Approach and Optimal Use

Klein

Kirton

2015

Curr Trauma Rep

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Angioembolization has revolutionized the management of pelvic-fracture-related hemorrhage. Along with pelvic immobilization and preperitoneal pelvic packing, angioembolization is an integral component in multidisciplinary algorithms for achieving hemostasis in severe pelvic trauma. Polytrauma, especially associated intraperitoneal injuries, adds to the complexity and complicates decisions related to the optimal care for these patients in hemorrhagic shock. The indications, timing, location, and technique for angioembolization differ based on available resources and expertise. Regional, institutional, and personal preferences add further variation to practice patterns and outcomes. While complications are associated with pelvic angioembolization, the actual causal relationship is questionable. Furthermore, angioembolization is frequently a life-saving maneuver without an effective alternative treatment. The wealth of recent literature will be pieced together to define the role that angioembolization should play in the management of pelvic fracture-related hemorrhage.

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Emergency angio-embolisation in the operating theatre for trauma patients using the C-Arm digital subtraction angiography

Cited by 12 publications

References 7 publications

Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Experience of damage control trauma laparotomy in a limited resource healthcare setting: A retrospective Cohort Study

Hybrid Trauma Management: Is It the Way We Are Heading?

Angioembolization: Indications, Approach and Optimal Use

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