Journal of EndoVascular Resuscitation and Trauma Management最新文献

{"title":"Partial REBOA","authors":"A. J. Davidson, T. Williams","doi":"10.1007/978-3-030-25341-7_7","DOIUrl":"https://doi.org/10.1007/978-3-030-25341-7_7","url":null,"abstract":"","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":"36 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90602725","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":"Comparison of Simulation Models for Training a Diverse Audience to Perform Resuscitative Endovascular Balloon Occlusion of the Aorta","authors":"C. Evans, Lisa L. Schlitzkus, A. Schiller, A. Kamenskiy, J. MacTaggart","doi":"10.26676/jevtm.v3i3.86","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.86","url":null,"abstract":"Background: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock is increasing, but questions remain about who to train and how best to train them. We developed a REBOA training curriculum and performed a pilot course teaching the technique to surgeons and non-surgeons using four different simulation models. \u0000Methods: A REBOA curriculum was created incorporating four simulation models: 1)virtual reality, 2)mannequin, 3)large animal live tissue, and 4)perfused cadaver. The course was taught to n=6 military personnel, including two surgeons, two emergency medicine physicians, and two non-physicians, none with prior REBOA experience. Performance using each model was recorded, and pre and post-course tests and surveys were administered. Simulation models were compared based on capabilities, learner preferences, and cost. \u0000Results: Learners gained confidence, and were successful performing REBOA in the perfused cadaver models. Higher-fidelity live tissue and cadaver models were preferred, and learners rated them as the most realistic. Virtual reality and mannequin simulation were rated the least realistic and most dispensable methods of learning. All simulation models required significant resource investment. \u0000Conclusions: A simplified curriculum, focusing only on the skills necessary to perform REBOA, may provide even non-medical personnel the confidence and competence to perform the procedure. Higher-fidelity perfused cadaver and live tissue models are preferred by learners, and future work is required to improve the usefulness of mannequin and virtual reality simulation for training. Though REBOA simulation education is expensive, it has the potential to help revolutionize military and civilian prehospital hemorrhage control.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42014510","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":"Successful fluoroscopy-free extremity endovascular revascularization in an austere environment: a case report","authors":"V. Reva, J. Morrison, Samokhvalov Im","doi":"10.26676/jevtm.v3i3.100","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.100","url":null,"abstract":"Background. The use of endovascular techniques in military trauma has increased over time. We present a case of stent-graft placement in a far-forward medical treatment facility (MTF). \u0000Methods. A 27 year-old male sustained a blast injury to his upper extremities. He was admitted to a Role 2 MTF 7 hours post-injury. On presentation, he was hemodynamically stable, with multiple closed fractures of both hands, a partial amputation of the right forearm, and the absence of right upper-extremity pulses. Plain radiographs revealed two metallic fragments overlying the right humerus head. \u0000The patient underwent a completion below-elbow amputation and right brachial artery exploration. Following the insertion of an arterial sheath, a multipurpose 5-Fr catheter was used to obtain a single-shot angiogram, which demonstrated a traumatic sub-total occlusion of the axillary artery. \u0000Using a combination of gentle catheter-wire manipulation and serial radiography, the lesion was traversed and access to normal subclavian artery obtained. A Fluency®Stent Graft (6x100 mm) was then deployed, followed by a completion angiogram, which demonstrated the restoration of extremity perfusion. \u0000Results.The patient was evacuated to the next echelon of care on day 5 with good perfusion of the extremity. CT-angiography on day 30 demonstrated thrombotic occlusion of the stent-graft; however, the extremity was viable and further revascularization was not clinically indicated. He was discharged on day 78 following conversion to internal osteosynthesis. \u0000Conclusion.Endovascular revascularization of extremity trauma is possible in an austere environment, although techniques need to be refined to support a reduced logistical footprint.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43186556","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":"Pediatric Blunt Trauma and REBOA","authors":"Alexis D. Smith","doi":"10.26676/jevtm.v3i3.103","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.103","url":null,"abstract":"No abstract","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47230136","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":"The Trauma-Vascular Surgeon: A Global Necessity","authors":"E. Moore","doi":"10.26676/jevtm.v3i3.102","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.102","url":null,"abstract":"No abstract","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44432629","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: Standing on the Shoulders of Giants","authors":"C. Fox","doi":"10.26676/jevtm.v3i3.101","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.101","url":null,"abstract":"No abstract","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48095571","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 Resuscitation with Aortic Balloon Occlusion in pediatric trauma","authors":"M. Sadeghi","doi":"10.26676/jevtm.v3i3.99","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.99","url":null,"abstract":"Background \u0000The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in resuscitation and trauma management in adults is increasing. However, there is limited data published concerning its use in pediatric patients. \u0000Methods \u0000We describe a case using REBOA for traumatic hemorrhagic shock in a pediatric patient according to the concept of EndoVascular resuscitation and Trauma Management (EVTM) at Örebro University Hospital in April 2019. Informed consent has been received. \u0000Results \u0000 An 11-year-old boy arrived to the emergency room (ER) after a motor vehicle accident. Due to total hemodynamic collapse, cardiopulmonary resuscitation was initiated with return of spontaneous circulation. Zone 1 total REBOA was successfully performed for 7 minutes while damage control surgery was performed and massive transfusion was initiated to stabilize the patient. The patient survived and returned to almost normal daily activity. \u0000Conclusion \u0000REBOA for endovascular resuscitation and trauma management may be an additional method for temporary hemodynamic stabilization in pediatric patients and, in this specific patient, was used instead of resuscitative thoracotomy. \u0000  \u0000Keywords: REBOA; Hemorrhage; Hemorrhagic Shock; Endovascular Resuscitation, Pediatric Trauma \u0000 ","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":"1 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41407091","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":"Embolization and its limits: Tips and Tricks","authors":"A. Ierardi, F. Pesapane, T. Hörer, V. Reva, G. Carrafiello","doi":"10.26676/jevtm.v3i3.96","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.96","url":null,"abstract":"Nowadays, the non-operative management is the preferred strategy, when possible. During the last years, improvement in embolic techniques and agents, make feasible and effective more conditions. \u0000In the present paper current indications, technical requirements, advantages and disadvantages, contraindications are discussed. Moreover particular attention is given to the limits of the embolization procedure, suggesting some tips documented by literature data to overcome these limits. The most feared limit/complication is the risk of non-target embolization, especially when target tissues are noble organs. \u0000Skilled interventional radiologists, inserted in an adequate multi-disciplinary team, have available tricks to limit risks, complications and failures.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43565844","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":"Is Time of the Essence: A Retrospective Analysis of Operating Room Procedure Length for First Phase Damage Control Trauma Surgery","authors":"Alison A Smith, L. Hakki, Jessica K. Friedman, R. Schroll, Chrissy Guidry, Patrick R. McGrew, D. Tatum, J. Duchesne","doi":"10.26676/jevtm.v3i3.97","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.97","url":null,"abstract":"Background:The concept of Damage Control Surgery (DCS) consists of a truncated surgical intervention with main focus on hemorrhage and contamination control. Traditionally,DCS involves limiting operating room (OR) time for patients with multiple life-threatening injuries and coagulopathy who are reaching physiologic exhaustion. However, in the modern era of hemostatic resuscitation, there is a paucity of evidence to support a survival benefit with shorter OR times. The objective of this study was to determine the practice habits of trauma surgeons in the modern era of DCS and to determine if operation length affects mortality in trauma patients with abdominal injuries. \u0000Methods:An 8-year retrospective review of consecutive adult patients with DCSfor penetrating abdominal trauma at a Level I trauma center was conducted. Patient demographics, injury severity score (ISS), and penetrating abdominal trauma index (PATI) scores were obtained. Average operating room times for initial DCS were determined. Patient outcomes were analyzed with a t-test for univariate analysis and a Cox proportional hazard ratio modeling was used to predict factors for survival.  \u0000Results:A total of 193 patients were included in the study.  The overall patient mortality was 14.0% (n=27/193). Median OR time was 157 minutes (range, 59-573 min). Patients were stratified into short OR group (SHORT, n=95) and long OR group (LORT, n=98) based on the median operative time. Only one patient had an initial DCL less than 60 minutes.  The SHORT group received more blood transfusions (52.6% vs. 35.7%, p=0.02) in the ICU. Average operative room time was almost twice as long in the LORT group (214.6+6.2 vs. 121.4+2.6 minutes, p<0.0001). The average hospital length of stay (22.8+2.3 vs. 31.0+3.5 days, p=0.05) and ICU length of stay (10.6+1.2 vs. 12.6+1.4 days, p=0.28) were both lower in the LORT group compared to the SHORT group. The SHORT group had 22 patients with unplanned return to the OR compared to 3 in the LORT group (p<0.0001). On multivariate analysis, OR time was not an independent risk factor for mortality (OR 1.0, 95% CI 0.98-1.0, p=0.48). \u0000Conclusions: Modern damage control practices should focus on early and effective surgical hemorrhage control in combination with effective intra-op hemostatic resuscitation efforts and not on how time limitations. These findings suggest that OR time restrictions in the era of effective hemostatic resuscitation in combination with DCS does not impact mortality.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42628698","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":"Approximation of Pediatric Morphometry for Resuscitative Endovascular Balloon Occlusion of the Aorta","authors":"Erik Desoucy, A. Trappey, Andrew M. Wishy, Meryl A. Simon, A. J. Davidson, J. Dubose, T. Williams, M. Johnson, Jacob T. Stephenson","doi":"10.26676/jevtm.v3i3.95","DOIUrl":"https://doi.org/10.26676/jevtm.v3i3.95","url":null,"abstract":"Background \u0000Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be beneficial in the management of traumatic and iatrogenic vascular and solid organ injuries in children, but requires an understanding of vessel diameter at the access site and landing zones. We sought to adapt the Broselow™ Tape method to estimation of aortic and femoral artery diameters for this purpose. \u0000Methods \u0000Computed tomography scans from trauma and non-trauma pediatric patients at a level 1 trauma center were reviewed for vascular dimensions at aorta Zone I, Zone III and the common femoral artery (CFA). Vessel size was measured by two providers using a vascular software suite with a 10% interobserver comparison. Height was used to create linear regression equations for each location and calculate ranges for each Broselow™ Tape category. \u0000Results \u0000We reviewed scans from 110 patients ages 2-14 years with less than 8% interobserver variability. 64% were male and 46% were trauma patients. Height based regression equations were closely correlated with vessel diameter: \u0000 Zone I(mm)=[0.093±0.006·height(cm)]+0.589±0.768; R2=0.714, p<0.001 \u0000Zone III(mm)=[0.083±0.005·height(cm)]–0.703±0.660; R2=0.728, p<0.001 \u0000CFA(mm)=[0.043±0.003·height(cm)]+0.644±0.419; R2=0.642, p<0.001 \u0000These equations, along with the minimum and maximum length for each Broselow™ Tape color, were used to define color coded normal ranges for each REBOA landing zone and access site. \u0000Conclusion \u0000Knowledge of the access vessel and occlusion zone diameters in pediatric patients is crucial for future research and application of REBOA in this population. Furthermore, an adapted Broselow™ Tape including these measurements would assist in appropriate sheath and balloon catheter selection in emergent settings.","PeriodicalId":41233,"journal":{"name":"Journal of EndoVascular Resuscitation and Trauma Management","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45778763","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}