The potential benefit of a hybrid operating environment among severely injured patients with persistent hemorrhage

Fehr, Adam; Beveridge, Julie; DʼAmours, Scott D; Kirkpatrick, Andrew W.; Ball, Chad G.

doi:10.1097/ta.0000000000000951

Cited by 23 publications

(22 citation statements)

References 12 publications

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“…Finally, severe unstable spleen injuries could ideally benefit from a resuscitation in a hybrid OR with trauma surgeons, in order to increase the spleen salvage rate [ 59 – 61 ].…”

Section: Adult Patientsmentioning

confidence: 99%

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

et al. 2017

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Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

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“…Finally, severe unstable spleen injuries could ideally benefit from a resuscitation in a hybrid OR with trauma surgeons, in order to increase the spleen salvage rate [ 59 – 61 ].…”

Section: Adult Patientsmentioning

confidence: 99%

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

et al. 2017

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“…Only a few patients could benefit from the utility of HOR or HER. 29 Moreover, REBOA can result in changes in the management of hemodynamically unstable patients with multiple injuries. Further studies are needed to confirm the optimal management strategy for severe trauma, including the appropriate physician, use of HOR or HER, and cost-effectiveness ratio.…”

Section: Discussionmentioning

confidence: 99%

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

Otsuka

Uehata

Sakoda

et al. 2020

Trauma Surg Acute Care Open

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BackgroundTrauma management requires a multidisciplinary approach, but coordination of staff and procedures is challenging in patients with severe trauma. In October 2014, we implemented a streamlined trauma management system involving emergency physicians trained in severe trauma management, surgical techniques, and interventional radiology. We evaluated the impact of streamlined trauma management on patient management and outcomes (study 1) and evaluated determinants of mortality in patients with severe trauma (study 2).MethodsWe conducted a retrospective cohort study of 125 patients admitted between January 2011 and 2019 with severe trauma (Injury Severity Score ≥16) and persistent hypotension (≥2 systolic blood pressure measurements <90 mm Hg). Patients were divided into a Before cohort (January 2011 to September 2014) and an After cohort (October 2014 to January 2019) according to whether they were admitted before or after the new approach was implemented. The primary outcome was in-hospital mortality.ResultsCompared with the Before cohort (n=59), the After cohort (n=66) had a significantly lower in-hospital mortality (36.4% vs. 64.4%); required less time from hospital arrival to initiation of surgery/interventional radiology (median, 41.0 vs. 71.5 minutes); and was more likely to undergo resuscitative endovascular balloon occlusion of the aorta (24.2% vs. 6.8%). Plasma administration before initiating hemostasis (adjusted OR 1.49 (95% CI 1.04 to 2.14)), resuscitative endovascular balloon occlusion of the aorta (9.48 (95% CI 1.25 to 71.96)), and shorter time to initiation of surgery/interventional radiology (0.97 (95% CI 0.96 to 0.99)) were associated with significantly lower mortality.DiscussionImplementing a streamlined trauma management protocol improved outcomes among hemodynamically unstable patients with severe multiple trauma.Level of evidenceLevel III.

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“…Partial inflation with controlled hypotensive target allowed benefits overcome risks of a defective procedure. REBOA adoption, even in a potentially dangerous position, gave authors time to move patient from OR to angiographic room (not available at the moment in our hospital a hybrid surgical angiographic suite) [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and time to find the primary source in a severe and multiple hemorrhagic trauma, with good clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Partial Zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in Management of Multiple Trauma with Combined Abdominal and Pelvic Injury

Gamberini¹,

Fabbri²,

Taioli³

et al. 2017

J Trauma Treat

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The potential benefit of a hybrid operating environment among severely injured patients with persistent hemorrhage

Abstract: Therapeutic study, level IV.

Cited by 23 publications

References 12 publications

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

Splenic trauma: WSES classification and guidelines for adult and pediatric patients

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

Partial Zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in Management of Multiple Trauma with Combined Abdominal and Pelvic Injury

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