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Resuscitative thoracotomy

Bellal Joseph, Kareem Ibraheem, Ansab A Haider, Narong Kulvatunyou, Andrew Tang, Terence O'Keeffe, Zachary M Bauman, Donald J Green, Rifat Latifi, Peter Rhee
BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings. METHODS: We performed a 4-year retrospective review of all RTs performed at our Level I trauma center...
November 2016: Journal of Trauma and Acute Care Surgery
Rifat Latifi, Jayleen K L Gunn, John A Stroster, Edmond Zaimi, Fatos Olldashi, Agron Dogjani, Mihal Kerci, Xheladin Draçini, Julian Kuçani, Zhaneta Shatri, Agim Kociraj, Arian Boci, Ross I Donaldson
BACKGROUND: Traumatic injuries have become a substantial but neglected epidemic in low- and middle-income countries (LMICs), but emergency rooms (ERs) in these countries are often staffed with healthcare providers who have minimal emergency training and experience. The aim of this paper was to describe the specialized training, available interventions, and the patient management strategies in the ERs in Albanian public hospitals. METHODS: A cross-sectional descriptive study of 42 ERs in the Republic of Albania between September 5, 2014, and December 29, 2014 was performed...
December 2016: International Journal of Emergency Medicine
H Drinhaus, T Annecke, J Hinkelbein
Decompression of the chest is a life-saving invasive procedure for tension pneumothorax, trauma-associated cardiopulmonary resuscitation or massive haematopneumothorax that every emergency physician or intensivist must master. Particularly in the preclinical setting, indication must be restricted to urgent cases, but in these cases chest decompression must be executed without delay, even in subpar circumstances. The methods available are needle decompression or thoracentesis via mini-thoracotomy with or without insertion of a chest tube in the midclavicular line of the 2nd/3rd intercostal space (Monaldi-position) or in the anterior to mid-axillary line of the 4th/5th intercostal space (Bülau-position)...
October 2016: Der Anaesthesist
S E van Oostendorp, E C T H Tan, L M G Geeraedts
INTRODUCTION: Exsanguination following trauma is potentially preventable. Extremity tourniquets have been successfully implemented in military and civilian prehospital care. Prehospital control of bleeding from the torso and junctional area's remains challenging but offers a great potential to improve survival rates. This review aims to provide an overview of potential treatment options in both clinical as preclinical state of research on truncal and junctional bleeding. Since many options have been developed for application in the military primarily, translation to the civilian situation is discussed...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Matthew J Bradley, Brandon W Bonds, Luke Chang, Shiming Yang, Peter Hu, Hsiao-Chi Li, Megan L Brenner, Thomas M Scalea, Deborah M Stein
BACKGROUND: Open chest cardiac massage (OCCM) is a commonly performed procedure after traumatic cardiac arrest (TCA). OCCM has been reported to be superior to closed chest compressions (CCC) in animal models and in non-TCA. The purpose of this study is to prospectively compare OCCM versus CCC in TCA using end-tidal carbon dioxide (ETCO2), the criterion standard for determining the effectiveness of chest compressions and detection of return of spontaneous circulation (ROSC), as the surrogate for cardiac output and marker for adequacy of resuscitation...
November 2016: Journal of Trauma and Acute Care Surgery
Jonathan P Meizoso, Juliet J Ray, Charles A Karcutskie, Casey J Allen, Tanya L Zakrison, Gerd D Pust, Tulay Koru-Sengul, Enrique Ginzburg, Louis R Pizano, Carl I Schulman, Alan S Livingstone, Kenneth G Proctor, Nicholas Namias
INTRODUCTION: Timely hemorrhage control is paramount in trauma; however, a critical time interval from emergency department arrival to operation for hypotensive gunshot wound (GSW) victims is not established. We hypothesize that delaying surgery for more than 10 minutes from arrival increases all-cause mortality in hypotensive patients with GSW. METHODS: Data of adults (n = 309) with hypotension and GSW to the torso requiring immediate operation from January 2004 to September 2013 were retrospectively reviewed...
October 2016: Journal of Trauma and Acute Care Surgery
Derek J Roberts, David A Zygun, Peter D Faris, Chad G Ball, Andrew W Kirkpatrick, Henry T Stelfox
BACKGROUND: Variation in use of damage control (DC) surgery across trauma centers may be partially driven by surgeon uncertainty as to when it is appropriately indicated. We sought to determine opinions of practicing surgeons on the appropriateness of published indications for trauma DC surgery. STUDY DESIGN: We asked 384 trauma centers in the United States, Canada, and Australasia to nominate 1 to 3 surgeons at their center to participate in a survey about DC surgery...
September 2016: Journal of the American College of Surgeons
S Barbois, J Abba, S Guigard, J L Quesada, A Pirvu, P A Waroquet, F Reche, O Risse, P Bouzat, F Thony, C Arvieux
This is a single center retrospective review of abdominal or abdomino-thoracic penetrating wounds treated between 2004 and 2013 in the gastrointestinal and emergency unit of the university hospital of Grenoble, France. This study did not include patients who sustained blunt trauma or non-traumatic wounds, as well as patients with penetrating head and neck injury, limb injury, ano-perineal injury, or isolated thoracic injury above the fifth costal interspace. In addition, we also included cases that were reviewed in emergency department morbidity and mortality conferences during the same period...
August 2016: Journal of Visceral Surgery
T Monchal, E Hornez, B Prunet, S Beaume, H Marsaa, S Bourgouin, Y Baudoin, S Bonnet, J-B Morvan, J-P Avaro, A Dagain, J-P Platel, P Balandraud
Severe trauma patients should be received at the hospital by a multidisciplinary team directed by a "trauma leader" and all institutions capable of receiving such patients should be well organized. As soon as the patient is accepted for care, the entire team should be prepared so that there is no interruption in the pre-hospital chain of care. All caregivers should thoroughly understand the pre-established protocols of diagnostic and therapeutic strategies to allow optimal management of unstable trauma victims in whom hemostasis must be obtained as soon as possible to decrease the morbid consequences of post-hemorrhagic shock...
August 2016: Journal of Visceral Surgery
Nathan H Schmoekel, James V O'Connor, Thomas M Scalea
The conventional treatment for an avulsed bronchus is emergent thoracotomy and repair or lobectomy. The principles of damage control thoracic operations include initial hemorrhage control with delayed definite repair after physiologic resuscitation. We report a multiply injured patient with avulsion of the left lower lobe bronchus. Profound acidosis, hypercarbia, and hypoxia precluded an emergent operation, and venovenous extracorporeal membrane oxygenation (V-V ECMO) was used for organ support during physiologic resuscitation...
June 2016: Annals of Thoracic Surgery
E W Stranch, B L Zarzaur, S A Savage
INTRODUCTION: Penetrating cardiac injuries are infrequent but highly lethal. To address these injuries, cardiopulmonary bypass and cardiothoracic surgery availability are required for Level I trauma center verification. However, acute care surgeons are more readily available for this time-sensitive injury. The purpose of this study was to review an acute care surgery-based experience with penetrating cardiac trauma at an urban Level 1 trauma center. Our hypothesis was that care provided solely by acute care surgeons was both safe and effective for this patient population...
May 18, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Bellal Joseph, Kareem Ibraheem, Ansab A Haider, Narong Kulvatunyou, Andrew Tang, Terence O'Keeffe, Zachary M Bauman, Donald J Green, Rifat Latifi, Peter Rhee
BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However; with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention like RT is being discussed. The aim of this study was to identify patients that most likely would have potentially benefitted from REBOA use based on autopsy findings. METHODS: We performed a four-year retrospective review of all RT performed at our Level I trauma center...
May 18, 2016: Journal of Trauma and Acute Care Surgery
Rachel M Russo, Lucas P Neff, Michael Austin Johnson, Timothy K Williams
Management of non-compressible torso hemorrhage (NCTH) remains a challenge despite continued advancements in trauma resuscitation. Resuscitative thoracotomy with aortic cross-clamping and recent advances in endovascular aortic occlusion, including resuscitative endovascular occlusion of the aorta, have finite durations of therapy due to the inherent physiologic stressors that accompany complete occlusion. Here, we attempt to illuminate the current state of aortic occlusion for trauma resuscitation including explanation of the deleterious consequences of complete occlusion, potential methods and limitations of existing technology to overcome these consequences, and a description of innovative methods to improve the resuscitation of NCTH...
September 2016: Shock
Hunter B Moore, Ernest E Moore, Clay C Burlew, Walter L Biffl, Fredric M Pieracci, Carlton C Barnett, Denis D Bensard, Gregory J Jurkovich, Charles J Fox, Angela Sauaia
BACKGROUND: Attempts are made with emergency department thoracotomy (EDT) to salvage trauma patients who present to the hospital in extremis. The EDT allows for relief of cardiac tamponade, internal cardiac massage, and proximal hemorrhage control. Minimally invasive techniques, such as endovascular hemorrhage control (EHC) are available, but their noninferiority to EDT remains unproven. Before adopting EHC, it is important to evaluate the current outcomes of EDT. We hypothesized that EDT survival has improved during the last 4 decades, and outcomes stratified by pre-hospital CPR and injury patterns will provide benchmarks for success-to-rescue and survival outcomes for patients in extremis...
July 2016: Journal of the American College of Surgeons
Gerd Daniel Pust, Nicholas Namias
Resuscitative thoracotomy is often performed on trauma patients with thoracoabdominal penetrating or blunt injuries arriving in cardiac arrest. The goal of this procedure is to immediately restore cardiac output and to control major hemorrhage within the thorax and abdominal cavity. Only surgeons with experience in the management of cardiac and thoracic injuries should perform this procedure.
April 14, 2016: International Journal of Surgery
Satoshi Ideno, Atsushi Shinto, Taku Matsuoka, Noriko Miyazawa, Shinichi Yamamoto
Tracheoinnominate artery fistula (TIF) is a relatively rare life-threating complication of long-term tracheostomy. Two patients with TIF were successfully resuscitated by extracorporeal membrane oxygenation (ECMO) support along with advanced cardiovascular life support. The first patient was a 16-year-old boy undergoing long-term tracheostomy because of cerebral palsy, and the other patient was a previously healthy 11-year-old girl who had undergone primary tracheal tumor resection. In both cases, the onset of TIF was sudden, and the patients were immediately transferred to the operating room for emergency thoracotomy under ongoing cardiopulmonary resuscitation...
February 2016: Masui. the Japanese Journal of Anesthesiology
Matthew M Carrick, Catherine Anne Morrison, Nicole M Tapia, Jan Leonard, James W Suliburk, Michael A Norman, Francis J Welsh, Bradford G Scott, Kathy R Liscum, Sally R Raty, Matthew J Wall, Kenneth L Mattox
BACKGROUND: Hemorrhagic shock is responsible for one third of trauma related deaths. We hypothesized that intraoperative hypotensive resuscitation would improve survival for patients undergoing operative control of hemorrhage following penetrating trauma. METHODS: Between July 1, 2007, and March 28, 2013, penetrating trauma patients aged 14 years to 45 years with a systolic blood pressure of 90 mm Hg or lower requiring laparotomy or thoracotomy for control of hemorrhage were randomized 1:1 based on a target minimum mean arterial pressure (MAP) of 50 mm Hg (experimental arm, LMAP) or 65 mm Hg (control arm, HMAP)...
June 2016: Journal of Trauma and Acute Care Surgery
Carlos A Ordoñez, Juan P Herrera-Escobar, Michael W Parra, Paola A Rodriguez-Ossa, David A Mejia, Alvaro I Sanchez, Marisol Badiel, Monica Morales, Johanna C Rojas-Mirquez, Maria P Garcia-Garcia, Luis F Pino, Juan C Puyana
BACKGROUND: Dynamic and efficient resuscitation strategies are now being implemented in severely injured hemodynamically unstable (HU) patients as blood products become readily and more immediately available in the trauma room. Our ability to maintain aggressive resuscitation schemes in HU patients allows us to complete diagnostic imaging studies before rushing patients to the operating room (OR). As the criteria for performing computed tomography (CT) scans in HU patients continue to evolve, we decided to compare the outcomes of immediate CT versus direct admission to the OR and/or angio suite in a retrospective study at a government-designated regional Level I trauma center in Cali, Colombia...
April 2016: Journal of Trauma and Acute Care Surgery
Mehdi Bamous, Abdou Abdessamad, Jawad Tadili, Ali Kettani, Mamoun Faroudy
BACKGROUND: The purpose of this study was to identify factors associated with unfavourable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from resuscitative effort. METHODS: From February to March, variables were collected from medical records of patients sustaining cardiac trauma. The inclusion criterion was the presence of a penetrating cardiac injury confirmed intraoperatively. RESULTS: Ninety-eight patients were admitted with penetrating cardiac injury...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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