Feasibility of intraoperative angioembolization for trauma patients using C-arm digital subtraction angiography

Alnumay, Abdulaziz; Caminsky, Natasha; Eustache, Jules; Valenti, David; Beckett, Andrew; Deckelbaum, Dan; Fata, Paola; Khwaja, Kosar; Razek, Tarek; McKendy, Katherine M.; Wong, Evan G.; Grushka, Jeremy

doi:10.1007/s00068-020-01530-x

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…Ongoing bleeding after external emergency stabilisation can be managed using either temporary retroperitoneal/PPP combined with laparotomy when needed and/or angioembolisation (AE) [ 220 – 222 ]. The critical decision to transfer a patient to the OR versus interventional radiology suite can be managed using intraoperative AE with C-arm digital subtraction angiography [ 221 ]. There was no significant difference in mortality observed between AE and PPP in patients with traumatic pelvic haemorrhage [ 223 ].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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“…A total of 18 of them were excluded because they did not focus on the primary subject, 5 of them were excluded because they were case reports and 2 of them were excluded because they were not written in the English language. Finally, a total of 10 studies were included in the review [9][10][11][12][13][14][15][16][17][18]. Almost all of them were retrospective studies and only one was an observational study.…”

Section: Resultsmentioning

confidence: 99%

“…However, this study postulated that the cost associated with a hybrid suite, where an advanced angiography system is available, remains prohibitive for many centers [28,29]. Another cheaper solution could be the use of a mobile C-arm in an operating room equipped with a carbon-fiber fluoroscopic table [11].…”

Section: Discussionmentioning

confidence: 99%

Damage Control Interventional Radiology in Liver Trauma: A Comprehensive Review

Corvino,

Giurazza,

Marra

et al. 2024

JPM

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The liver is the second most common solid organ injured in blunt and penetrating abdominal trauma. Non-operative management (NOM) has become the standard of care for liver injuries in stable patients, where transarterial embolization (TAE) represents the main treatment, increasing success rates and avoiding invasive surgical procedures. In hemodynamically (HD) unstable patients, operative management (OM) is the standard of care. To date, there are no consensus guidelines about the endovascular treatment of patients with HD instability or in ones that responded to initial infusion therapy. A review of the literature was performed for published papers addressing the outcome of using TAE as the primary treatment for HD unstable/transient responder trauma liver patients with hemorrhagic vascular lesions, both as a single treatment and in combination with surgical treatment, focusing additionally on the different definitions used in the literature of unstable and transient responder patients. Our review demonstrated a good outcome in HD unstable/transient responder liver trauma patients treated with TAE but there still remains much debate about the definition of unstable and transient responder patients.

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“…[14] Other centers in Canada also allow for a hybrid operating room through integration of a C-arm and having rapid access to an interventional radiologist, avoiding transfer of the patients between the operating room and the angiography suite. [15] Another example of advanced technology is REBOA (resuscitative endovascular balloon occlusion of the aorta). In a survey of all levels I and II trauma centers in Canada, as of July 2021, 21.9% (7/32) had a REBOA program, and these are located in 3 provinces: British Columbia, Ontario, and Quebec.…”

Section: Positivementioning

confidence: 99%

Trauma systems in Canada: striving for quality across an expansive landmass

Caminsky

Wong

2023

Emerg Crit Care Med

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Although Canada has a universal health care program that provides free in-hospital services to all citizens, its vast landmass and nonstandardized prehospital and posthospital systems make delivering quality trauma care challenging, particularly to resource-limited rural regions. This article summarizes the strengths of the prehospital system, facility-based care, trauma network, trauma registry, rehabilitation, and governance/financing/quality assurance components of Canada’s trauma system. Future directions, including the use of telemedicine, standardization of practices, and resource optimization, are also explored. Canada’s trauma system is well developed, yet geography impedes equitable access. More standardization and resource optimization are needed.

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Feasibility of intraoperative angioembolization for trauma patients using C-arm digital subtraction angiography

Cited by 3 publications

References 11 publications

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

Damage Control Interventional Radiology in Liver Trauma: A Comprehensive Review

Trauma systems in Canada: striving for quality across an expansive landmass

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