Journal of EndoVascular Resuscitation and Trauma Management最新文献

{"title":"Unstable Without a Source: The Non-Diagnostic Triad in Hypotensive Blunt Trauma Victims","authors":"R. Reily, T. Simpson, M. Evans, Alison Smith, J. Duchesne","doi":"10.26676/jevtm.v3i1.83","DOIUrl":"https://doi.org/10.26676/jevtm.v3i1.83","url":null,"abstract":"Background: Current algorithms for resuscitation in blunt trauma patients rely on chest x-ray, FAST, and pelvic x-ray to quickly elicit a source of major bleeding in the trauma bay.  There are currently no good recommendations for the patient in whom all three of these imaging studies are negative.  \u0000Methods:  We identified blunt trauma victims who presented with a systolic blood pressure below 100mmHg.  Chest x-ray, FAST, and pelvic x-ray obtained in the trauma bay were reviewed, and patients who had all three studies negative underwent thorough chart review and characterization of injuries.   \u0000Results:  Of the total hypotensive blunt trauma victims (n=649), we found 47 who had a “non-diagnostic triad” (NDT).  Of the NDT group, 31.9% (n=15) were found to have a major injury contributing to hypotension, while 61% (n=29) were not diagnosed with a severe injury that could have contributed to hypotension.  Of the NDT group with severe injury, 40% (n=6) were found to have retroperitoneal bleeding, 40% (n=6) were found to have intraperitoneal bleeding despite negative fast, 13% (n=2) were thought to have spinal shock, and one patient had a blunt cardiac injury.    \u0000Conclusions:  Most of the NDT group patients in this study were not diagnosed with a serious injury.  However, a significant minority (31%) were found to have a major injury contributing to hypotension.  Of these patients, retroperitoneal and/or intra-abdominal bleeding were found in 80%, with neurogenic and cardiogenic shock less common.  We feel these sicker NDT patients may benefit from REBOA, although more study is warranted before formal algorithms and recommendations are made. ","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48478236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is a REBOA Non-Responder Trying To Tell Us","authors":"R. Reily","doi":"10.26676/JEVTM.V3I1.70","DOIUrl":"https://doi.org/10.26676/JEVTM.V3I1.70","url":null,"abstract":"Background:  With the growing use of REBOA as an alternative to E.D. thoracotomy in select patients, the algorithms are still evolving, and current guidelines for REBOA use appear to have gaps as evidenced by this case.  Most algorithms include chest x-ray, FAST, and pelvic x-ray to guide where to place the device, either zone 1 or zone 3.  There is a lack of guidance for patients in whom all three of these studies are negative, which we define as a non-diagnostic triad (NDT).  Furthermore, there is a lack of guidance after placement of the device in patients who fail to respond or only minimally respond.  \u0000Methods:  We describe a difficult case where a blunt trauma patient with unstable hemodynamics had marginal response to placement of zone 1 REBOA, while physical exam and imaging in the trauma bay did not reveal a source for his hypotension.  \u0000Results:  The patient was sent to the CT scanner whereupon multiple injuries were identified and detailed in the case.  The patient unfortunately expired soon after.  \u0000Conclusions:  Further clinical studies with better classification are needed in order to better understand the significance of REBOA responders and non-responders in patients with an unknown source of hypotension.  The non-diagnostic triad of negative chest x-ray, FAST, and pelvic x-ray, defined as non-diagnostic triad (NDT) represent a significantly challenging patient population that should be studied further. ","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49313712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AORTA Registry 7F vs 11-12 F access","authors":"Reviewer Joseph DuBose, J. Morrison, M. Brenner, Laura J Moore, J. Holcomb, K. Inaba, Jeremy W. Cannon, M. Seamon, D. Skarupa, E. Moore, C. Fox, Joseph A. Ibrahim, T. Scalea","doi":"10.26676/JEVTM.V3I1.79","DOIUrl":"https://doi.org/10.26676/JEVTM.V3I1.79","url":null,"abstract":"ABSTRACT \u0000Introduction:  The introduction of low profile devices designed for Resuscitative \u0000Endovascular Balloon Occlusion of the Aorta (REBOA) after trauma has the potential to \u0000change practice, outcomes and complication profiles related to this procedure. \u0000Methods: The AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care \u0000Surgery (AORTA) registry was utilized to identify REBOA patients from 16 centers \u0000-comparing presentation, intervention and outcome variables for those REBOA via \u0000traditional 11-12 access platforms and trauma-specific devices requiring only 7 F access. \u0000Results:From Nov 2013-Dec 2017, 242 patients with completed data were identified, \u0000constituting 124 7F and 118 11-12F uses. Demographics of presentation were not \u0000different between the two groups, except that the 7F patients had a higher mean ISS (39.2 \u0000 \u000034.1, p = 0.028). 7F device use was associated with a lower cut-down requirement for \u0000 \u0000access (22.6% vs. 37.3%, p = 0.049) and increased ultrasound guidance utilization (29.0% \u0000 \u000023.7%, p = 0.049). 7F device afforded earlier aortic occlusion in the course of \u0000 \u0000resuscitation (median 25.0 mins vs. 30 mins, p = 0.010), and had lower median PRBC \u0000(10.0 vs. 15.5 units, p = 0.006) and FFP requirements (7.5 vs. 14.0 units, p = 0.005). 7F \u0000patients were more likely to survive 24 hrs (58.1% vs. 42.4%, p = 0.015) and less likely \u0000to suffer in-hospital mortality (57.3% vs. 75.4%, p = 0.003). Finally, 7F device use was \u0000associated with a 4X lower rate of distal extremity embolism (20.0% vs. 5.6%, p = \u00000.014;OR 95% CI 4.25 [1.25-14.45]) compared to 11-12F counterparts. \u0000Conclusion: The introduction of trauma specific 7F REBOA devices appears to have \u0000influenced REBOA practices, with earlier utilization in severely injured hypotensive \u0000patients via less invasive means that are associated with lower transfusion requirements \u0000fewer thrombotic complications and improved survival. Additional study is required to determine optimal REBOA \u0000utilization.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48717018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prompt procedures to hemodynamically unstable pelvic fracture patients.","authors":"Kumiko Tanaka, Y. Matsumura, J. Matsumoto","doi":"10.26676/jevtm.v3i1.75","DOIUrl":"https://doi.org/10.26676/jevtm.v3i1.75","url":null,"abstract":"Backgroud: Angioembolization is a widely accepted method for an effective and useful hemostasis procedure in pelvic fracture (PF) patients. We evaluated and introduce the time course of the initial management and angiography in HU pelvic fracture patients. Methods: We retrospectively reviewed 56 PF patients who underwent IR from May 2010 to Dec 2016. We defined arrival to angiographytime (ATAT), it was recorded in all enrolled patients in which the first angiography image represented the initiation of angiography. We also evaluated total embolization time (TET) and single artery embolization time (SAET; time for artery selection, injection, embolization, and confirmation). \u0000Results: The median ATAT and TET was respectively 73 and 33 minutes. They were much faster than the previous reports. \u0000Conclusions: Our trauma IR strategy with specialized team might contribute to shorten the management time. \u0000 ","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49522760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitative endovascular balloon occlusion of the aorta (REBOA) enables operative management of the peripartum trauma patient in hemorrhagic shock","authors":"K. Allenson, Laura J Moore","doi":"10.26676/jevtm.v3i1.78","DOIUrl":"https://doi.org/10.26676/jevtm.v3i1.78","url":null,"abstract":"Trauma related injury is the leading cause of non-obstetric maternal death.  The gravid uterus is at risk for injury, particularly during motor vehicle accidents.  Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a means of controlling pelvic hemorrhage in the setting of trauma.  We report the use of REBOA in a hemodynamically unstable, multiply-injured young woman with viable intrauterine pregnancy.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44504496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).","authors":"V. Chiarini","doi":"10.26676/jevtm.v3i1.74","DOIUrl":"https://doi.org/10.26676/jevtm.v3i1.74","url":null,"abstract":"BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49626798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JEVTM February 2019","authors":"T. Hörer","doi":"10.26676/JEVTM.V3I1.82","DOIUrl":"https://doi.org/10.26676/JEVTM.V3I1.82","url":null,"abstract":"Editorial. no abstract needed","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43388045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Automated Endovascular Variable Aortic Control Device to Expand Function of Standard REBOA Catheters","authors":"T. Williams","doi":"10.26676/JEVTM.V3I1.65","DOIUrl":"https://doi.org/10.26676/JEVTM.V3I1.65","url":null,"abstract":"Abstract \u0000Background \u0000Endovascular methods for hemorrhage control, including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), are evolving and are increasingly being applied clinically. Partial flow strategies to mitigate the consequences of complete aortic occlusion have been demonstrated in pre-clinical models to enhance REBOA and expand its application to various shock states. Initial studies demonstrated that controlled partial flow requires precision beyond the capabilities of manual balloon volume adjustment, therefore automation is required. Our group previously developed a proof-of-concept computer-controlled extracorporeal flow circuit capable of precision aortic flow regulation, but it was not clinically applicable. To bring this concept closer to clinical applicability, we have developed the first endovascular strategy to achieve precision aortic flow regulation, termed Endovascular Variable Aortic Control (EVAC). \u0000Methods \u0000Following instrumentation, 5 Yorkshire-cross swine were subjected to controlled 25% hemorrhage, followed by precision low volume aortic flow regulation using a commercially available compliant balloon catheter pre-positioned in the descending thoracic aorta, connected to a custom, wireless syringe pump. Closed-loop feedback algorithms based on streaming physiologic data were used to determine balloon volume changes. \u0000Results \u0000The EVAC syringe pump was highly effective at maintaining precise aortic flow throughout the 45-minute intervention period during steady state conditions as well as during rapid fluid administration. Aortic flow and distal mean arterial pressure remained stable during EVAC, despite changing proximal hemodynamics. Balloon volume was dynamic, averaging over 500 changes during intervention, with a mean volume change of 6.7 uL and a maximal change of 100 uL. \u0000Conclusion \u0000The EVAC syringe pump is capable of achieving aortic flow regulation with high precision, beyond what is achievable with manual control. This serves as a model for future device design, enabling as-of-yet unachievable clinical therapies for hemorrhage and shock states. Future technological development is required to fully translate this into clinical use. \u0000Level of Evidence – Level V \u0000Study Type – Translational Science \u0000Keywords – EVAC, P-REBOA, REBOA, automation, hemorrhage \u0000  \u0000  \u0000  \u0000 ","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49019645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Repair of the Blunt Injury to Persistent Sciatic Artery in case of Pelvic Fracture","authors":"G. Greenberg","doi":"10.26676/jevtm.v3i1.76","DOIUrl":"https://doi.org/10.26676/jevtm.v3i1.76","url":null,"abstract":"Background: Endovascular embolization has become a preferred treatment in the management of retroperitoneal bleeding due to pelvic injuries. These techniques have spread across most trauma centers as minimally invasive management of one of the most dreadful conditions in trauma. Methods We present a patient with persistent sciatic artery who arrived at our facility with blunt pelvic trauma suffering from retroperitoneal bleeding. Timely recognition of this anomaly led to the preservation of the vital artery and prevention of the ischemic complication. Conclusions Though embolization of the bleeding has become a routine procedure in most busy trauma centers, precise imaging, recognition of significant anatomic variants and careful intervention planning are essential to prevent substantial complications.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41595407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Embolisation of a ruptured renal artery aneurysm","authors":"Y. Chan, G. Athanasiadis, Athanasios Pantos, S. Spiliopoulos, A. Wilson","doi":"10.26676/jevtm.v3i1.69","DOIUrl":"https://doi.org/10.26676/jevtm.v3i1.69","url":null,"abstract":"Renal artery aneurysm (RAA) is a rare clinical entity with an incidence rate of 0.1%. Clinically, only one-third of patients are symptomatic and growth rate has been reported to be slow. Elective management of RAA is only recommended if the size is >2cm in diameter. However, in cases of an acute rupture, mortality is 10%. We present an image of interest of an emergency ruptured renal artery aneurysm managed endovascularly. ","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45733400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}