First establishment of a new table-rotated-type hybrid emergency room system

Watanabe, Hiroaki; Shimojo, Yoshihide; Hira, Eiji; Kuramoto, Shunsuke; Muronoi, Tomohiro; Oka, Kazuyuki; Kidani, Akihiko

doi:10.1186/s13049-018-0532-z

Cited by 20 publications

(16 citation statements)

References 4 publications

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“…We have not experienced enough number of trauma patients who required emergency VV ECMO to clarify the safeness and promptness of emergency VV ECMO introduced in the Hybrid ER. At present, 11 trauma centres have installed a Hybrid ER in Japan [17]. To further reveal the efficiency of our system in tracheobronchial injury, we need to collect and evaluate more cases in which definitive interventions with VV ECMO were performed.…”

Section: Discussionmentioning

confidence: 99%

A paediatric case of severe tracheobronchial injury successfully treated surgically after early CT diagnosis and ECMO safely performed in the hybrid emergency room

Wada

Hayakawa

Maruyama

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background In paediatric trauma patients, tracheobronchial injury can be a rare, life-threatening trauma. In 2011, we instituted a new trauma workflow concept called the hybrid emergency room (Hybrid ER) that combines a sliding CT scanning system with interventional radiology features to permit CT examination and emergency therapeutic intervention without moving the patient. Extracorporeal membrane oxygenation (ECMO) can lead to cannula-related complications. However, procedures supported by moveable C-arm fluoroscopy and ultrasonography equipment can be performed soon after early CT examination. We report a paediatric patient with tracheobronchial injury diagnosed by CT examination who underwent rapid resuscitation and safe installation of veno-venous (VV) ECMO in our Hybrid ER and was successfully treated by surgery. Case presentation A 11-year-old boy was admitted to our Hybrid ER suffering blunt chest trauma. His vital signs were unstable with low oxygen saturation. Early CT examination was performed without relocation. CT revealed bilateral hemopneumothorax, bilateral lung contusion, left multiple rib fractures, and right bronchus intermedius injury. Because his oxygenation was severely low with a PaO 2 /FiO 2 ratio (P/F) of 109, he was at very high risk during transport to the operating room and changing to one-lung ventilation. Thus, we established VV ECMO in the Hybrid ER before we performed thoracotomy under left lung ventilation in the operating room. After the P/F ratio improved, he was transferred to the operating room under VV ECMO. We performed middle- and lower-lobe resection and sutured the stump of the right bronchus intermedius to treat the complete tear of this branch. After his respiratory function recovered, VV ECMO was removed on postoperative day 5. After in-patient rehabilitation, he was discharged home on postoperative day 68 without sequelae. Conclusions It is feasible to perform VV ECMO in the Hybrid ER, but one case does not conclude it is safe. In this case, the blood oxygenation improved, but there are no evidence to support the safety of the procedure or the advantage of ECMO initiation in the Hybrid ER rather than in the operating room.

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Section: Discussionmentioning

confidence: 99%

A paediatric case of severe tracheobronchial injury successfully treated surgically after early CT diagnosis and ECMO safely performed in the hybrid emergency room

Wada

Hayakawa

Maruyama

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…The Shimane Advanced Trauma Center of Shimane University Hospital installed a rotation-type hybrid ER system in August 2018 (Fig. 2 ) [ 12 ]. Our hybrid ER utilizes an operating table, not an angiographic table, and has an air-conditioned room (class 10,000) (12).…”

Section: Methodsmentioning

confidence: 99%

Hybrid emergency rooms reduce the requirement of blood transfusion in patients with severe trauma

et al. 2021

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Background A hybrid emergency room (ER) is defined as an emergency unit with four functions—performing resuscitation, computed tomography (CT), surgery, and angiography. However, the safety and efficacy of performing CT in a hybrid ER are unclear in primary surveys. Therefore, this study aimed to evaluate the safety and clinical effects of hybrid ERs. Methods This retrospective observational study used data from the Shimane University Hospital Trauma Database from January 2016 to February 2019. Hospitalized patients with severe trauma and an injury severity score of ≥ 16 were divided into the non-hybrid ER group (n = 134) and the hybrid ER group (n = 145). The time from arrival to CT and interventions and the number of in-hospital survivors, preventable trauma deaths (PTD), and unexpected survivors (US) were assessed in both groups. Further, the amount of blood transfused was compared between the groups using propensity score matching. Results The time from arrival to CT and interventions was significantly reduced in the hybrid ER group compared to that in the non-hybrid ER group (25 vs. 6 min; p < 0.0001 and 101 vs. 41 min; p = 0.0007, respectively). There was no significant difference in the rate of in-hospital survivors (96.9% vs. 96.3%; p = 0.770), PTD (0% vs. 0%), and US (9.0 vs. 6.2%; p = 0.497) between the groups. The amount of blood transfused was significantly lower in the hybrid ER group than in the non-hybrid ER group (whole blood 14 vs. 8, p = 0.004; red blood cell 6 vs. 2, p = 0.012; fresh frozen plasma 9 vs. 6, p = 0.021). This difference was maintained after propensity score matching (whole blood 28 [10–54] vs. 6 [4–16.5], p = 0.015; RBC 8 [2.75–26.5] vs. 2 [0–8.5], p = 0.020, 18 [5.5–27] vs. 6 [3.5–7.5], p = 0.057). Conclusions The study results suggest that trauma treatment in a hybrid ER is as safe as conventional treatment performed in a non-hybrid ER. Further, hybrid ERs, which can reduce the time for trauma surveys and treatment, do not require patient transfer and can reduce the amount of blood transfused during resuscitation.

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“…2). (10) Our hybrid ER utilizes an operating table but not an angiographic table and has an air-conditioned room (class 10,000) (10). Therefore, all surgeries, including craniotomy, can be performed in this hybrid ER without transferring patients.…”

Section: Management In Hybrid Ersmentioning

confidence: 99%

Hybrid emergency room reduces blood transfusion for patients with severe trauma

Watanabe¹,

Matsumoto²,

Kuramoto³

et al. 2021

Preprint

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Background: A hybrid emergency room (hybrid ER) is defined as an emergency unit with four functions: resuscitation, computed tomography (CT) scanning, performing operations, and angiography. The safety and efficacy of performing CT scans in a hybrid ER is not well known in the primary survey. The purpose of this study was to evaluate the safety and clinical effects of hybrid ERs. Methods: This was a retrospective observational study using the Shimane University Hospital Trauma Databank from January 2016 to February 2019. Hospitalized patients with severe trauma and an injury severity score ≥ 16 were divided into two groups: the non-hybrid ER group (n=134) and the hybrid ER group (n=145). The time from arrival to CT scan and interventions, and number of in-hospital survivors, preventable trauma deaths (PTD), and unexpected survivors (US) were assessed between both groups. The amount of blood transfused was also compared between the groups. Results: The time from arrival to CT scan and interventions was significantly reduced in the hybrid ER group compared with than in the non-hybrid ER group (25 vs. 6 minutes; p <0.0001, 101 vs. 41 minutes; p =0.0007). There was no significant difference in the rate of in-hospital survivors (96.9 vs. 96.3%; p=0.770), PTD (0 vs. 0%), and US (9.0 vs. 6.2%; p=0.497) between the groups. The amount of blood transfused was significantly reduced in the hybrid ER group compared to the non-hybrid ER group (red blood cell: 6 vs. 2, p =0.012, fresh frozen plasma: 9 vs. 6, p =0.021). Conclusions: The results of our study suggest that trauma treatment in a hybrid ER is as safe as previous conventional treatment in a non-hybrid ER, and that hybrid ERs, which can reduce the time for trauma surveys and treatment and do not require patient transfer, can reduce the amount of blood transfusion required for resuscitation.

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First establishment of a new table-rotated-type hybrid emergency room system

Cited by 20 publications

References 4 publications

A paediatric case of severe tracheobronchial injury successfully treated surgically after early CT diagnosis and ECMO safely performed in the hybrid emergency room

A paediatric case of severe tracheobronchial injury successfully treated surgically after early CT diagnosis and ECMO safely performed in the hybrid emergency room

Hybrid emergency rooms reduce the requirement of blood transfusion in patients with severe trauma

Hybrid emergency room reduces blood transfusion for patients with severe trauma

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