Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

Abdelrahman

Barah

et al. 2020

Preprint

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Background: Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center.Methods: We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients’s data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry.Results: A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury , 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock Index and more blood transfusion Absorbable particles (Gelfoam) was the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95% respectively with low rebleeding and complication rates. The hospital and ICU length of stay were13 and 6 days respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%. Conclusion: Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.

Section: Discussionmentioning

confidence: 51%

Section: Data Collectionmentioning

confidence: 99%

Utility Of Angioembolization In Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis From A Level 1 Trauma Center

Abdelrahman

Barah

et al. 2020

Preprint

Self Cite

“…Previous studies showed that shock index ≥0.80 after injury can be used to predict the early need for MTP, laparotomy and mortality. 12 The current study showed that the mean shock index for the cohort was greater than 0.80 and this figure was more likely seen post-hepatic (SI=0.91) and pelvic (SI=0.90) injury.…”

Section: Discussionmentioning

confidence: 52%

“…Admission SI was defined as the initial HR divided by simultaneous SBP reading. 12 Technical successful embolization was defined as cessation of vascular abnormality in post angioembolization (contrast medium extravasation, pseudoaneurysm and http://doi.org/10.2147/TCRM.S303518…”

Section: Data Collectionmentioning

confidence: 99%

Utility of Angioembolization in Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis from a Level 1 Trauma Center

Abdelrahman

Barah

et al. 2021

TCRM

Self Cite

Background: Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical and/or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center. Methods: We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients' data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry. Results: A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury, 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of the patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock index and more blood transfusion. Absorbable particles (Gelfoam) were the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95%, respectively, with low rebleeding and complication rates. The hospital and ICU length of stay were 13 and 6 days, respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%. Conclusion:Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.

“…Scoring systems: shock index (SI), abbreviated injury score (AIS), Injury severity core (ISS), and Sequential Organ Failure Assessment (SOFA) score. SI was de ned as admission heart rate divided by systolic blood pressure (normal value 0.5-0.7) [18,19]. The respiratory ECMO survival prediction (RESP) scores were calculated for each patient, which ranges between -22 and 15.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Post-traumatic Acute respiratory distress syndrome (ARDS) with and without Extracorporeal membrane oxygenation (ECMO) at A Level-1 Trauma Center

Al-Hassani

El‐Menyar

et al. 2021

Preprint

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Purpose: We aimed to evaluate the outcomes of post-traumatic acute respiratory distress syndrome (ARDS) in patients with and without Extracorporeal membrane oxygenation (ECMO) support.Methods: A retrospective analysis was conducted for trauma patients who developed ARDS at a level I trauma facility between 2014 and 2020. Data were analyzed and compared between ECMO and non-ECMO group.Results: We identified 85 patients with ARDS (22 patients had ECMO support and 63 matched patients managed by the conventional mechanical ventilation. The two groups were comparable for age, sex, injury severity score, abbreviated injury score, shock index, SOFA score, and head injury. Kaplan Meier survival analysis showed that the survival in the ECMO group was initially close to that of the non-ECMO, however, during follow-up, the survival rate was better in the ECMO group, but did not reach statistical significance (Log-rank, p=0.43 and Tarone-Ware, p=0.37). Multivariable logistic regression analysis showed that acute kidney injury (AKI) (Odds ratio 13.03; 95% CI 3.17-53.54) and brain edema (Odds ratio 4.80; 95% CI 1.10-21.03) were independent predictors of mortality. Sub-analysis showed that in patients with severe Murray Lung Injury (MLI) scores, non-ECMO group had higher mortality than the ECMO group (100% vs 36.8%, p=0.004).Conclusion: Although ARDS is uncommon in trauma patients, it has a high mortality. ECMO therapy was used in a quarter of ARDS cases. AKI and brain edema were the predictors of mortality among ARDS patients. ECMO use did not worsen the outcome in trauma patients; however, the survival was better in those who had severe MLI and ECMO support. Further prospective study is needed to define the appropriate selection criteria for the use of ECMO to optimize the outcomes in trauma patients.