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Resuscitative thoracotomy

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https://www.readbyqxmd.com/read/27894499/resuscitative-endovascular-balloon-occlusion-of-the-aorta-indications-outcomes-and-training
#1
REVIEW
Lena M Napolitano
Exsanguinating torso hemorrhage is a leading killer of trauma patients. The most appropriate means of hemorrhage control must be used. Trauma surgeons should have expertise with all approaches for prompt hemorrhage control [laparotomy, thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA), and resuscitative thoracotomy]. REBOA is an exciting adjunct for hemorrhage control as it can be deployed quickly and placed percutaneously. Balloon inflation can vary dependent on patient physiology...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27887010/technical-note-rapid-large-volume-resuscitation-at-resuscitative-thoracotomy-by-intra-cardiac-catheterization
#2
Shamir O Cawich, Vijay Naraynsingh
An emergency thoracotomy may be life-saving by achieving four goals: (i) releasing cardiac tamponade, (ii) controlling haemorrhage, (iii) allowing access for internal cardiac massage and (iv) clamping the descending aorta to isolate circulation to the upper torso in damage control surgery. We theorize that a new goal should be achieving rapid, large-volume fluid resuscitation and we describe a technique to achieve this.
November 24, 2016: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/27871682/factors-affecting-mortality-after-penetrating-cardiac-injuries-10-year-experience-at-urban-level-i-trauma-center
#3
Michael J Mina, Rashi Jhunjhunwala, Rondi B Gelbard, Stacy D Dougherty, Jacquelyn S Carr, Christopher J Dente, Jeffrey M Nicholas, Amy D Wyrzykowski, Jeffrey P Salomone, Gary A Vercruysse, David V Feliciano, Bryan C Morse
BACKGROUND: Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. METHODS: From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. RESULTS: Over the 10-year study, 80 PCI patients survived to reach the hospital...
October 15, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27853843/endovascular-solutions-for-the-management-of-penetrating-trauma-an-update-on-reboa-and-axillo-subclavian-injuries
#4
REVIEW
B C Branco, J J DuBose
PURPOSE: Endovascular procedures continue to gain acceptance as management options for penetrating traumatic injuries. Currently, several areas of potential endovascular application are being investigated. However, the bulk of the literature on this topic is still limited to case series or small retrospective studies. Therefore, we performed a review of the published experience involving the application of endovascular therapy to trauma patients who have sustained penetrating injuries with focus on outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) and endovascular repair of axillo-subclavian injuries...
November 16, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/27819221/concealed-resuscitation-related-injuries-as-reversible-cause-of-recurrent-arrest-following-extracorporeal-cardiopulmonary-resuscitation
#5
Kap Su Han, Sung Woo Lee, Kwang Hoon Park, Jong Su Park, Jae Seung Jung, Cheol Woong Yu, Su Jin Kim
A life-threatening cardiopulmonary resuscitation (CPR)-related injury can cause recurrent arrest after return of circulation. Such injuries are difficult to identify during resuscitation, and their contribution to failed resuscitation can be missed given the limitations of conventional CPR. Extracorporeal cardiopulmonary resuscitation (ECPR), increasingly being considered for selected patients with potentially reversible etiology of arrest, may identify previously occult CPR-related injuries by restoring arterial pressure and flow...
November 7, 2016: CJEM
https://www.readbyqxmd.com/read/27799653/-reboa-is-it-really-safe-a-case-with-massive-intracranial-hemorrhage-possibly-due-to-endovascular-balloon-occlusion-of-the-aorta-reboa
#6
Hayaki Uchino, Nobuichiro Tamura, Ryosuke Echigoya, Tetsunori Ikegami, Toshio Fukuoka
BACKGROUND Non-compressible torso hemorrhage continues to be the leading cause of preventable death in trauma patients. Recent case series report that resuscitative endovascular balloon occlusion of the aorta (REBOA) in the trauma population is a technically feasible method to manage the patients with exsanguinating hemorrhage. On the other hand, it seems that REBOA is being widely promoted prematurely. Complications due to REBOA haven't been reported much in the literature, and they could have been underestimated...
November 1, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27787569/-cardiopulmonary-resuscitation-in-cardiac-arrest-following-trauma
#7
B A Leidel, K-G Kanz
For decades, survival rates of cardiac arrest following trauma were reported between 0 and 2 %. Since 2005, survival rates have increased with a wide range up to 39 % and good neurological recovery in every second person injured for unknown reasons. Especially in children, high survival rates with good neurologic outcomes are published. Resuscitation following traumatic cardiac arrest differs significantly from nontraumatic causes. Paramount is treatment of reversible causes, which include massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade...
October 27, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/27768660/identifying-potential-utility-of-resuscitative-endovascular-balloon-occlusion-of-the-aorta-an-autopsy-study
#8
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
https://www.readbyqxmd.com/read/27718129/the-readiness-of-emergency-and-trauma-care-in-low-and-middle-income-countries-a-cross-sectional-descriptive-study-of-42-public-hospitals-in-albania
#9
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
https://www.readbyqxmd.com/read/27629501/-chest-decompression-in-emergency-medicine-and-intensive-care
#10
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
https://www.readbyqxmd.com/read/27623805/prehospital-control-of-life-threatening-truncal-and-junctional-haemorrhage-is%C3%A2-the-ultimate-challenge-in-optimizing-trauma-care-a-review-of-treatment-options-and-their-applicability-in-the-civilian-trauma-setting
#11
REVIEW
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...
September 13, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27537507/open-chest-cardiac-massage-offers-no-benefit-over-closed-chest-compressions-in-patients-with-traumatic-cardiac-arrest
#12
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
https://www.readbyqxmd.com/read/27488491/effect-of-time-to-operation-on-mortality-for-hypotensive-patients-with-gunshot-wounds-to-the-torso-the-golden-10-minutes
#13
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
https://www.readbyqxmd.com/read/27321388/opinions-of-practicing-surgeons-on-the-appropriateness-of-published-indications-for-use-of-damage-control-surgery-in-trauma-patients-%C3%A2-an%C3%A2-international-cross-sectional-survey
#14
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
https://www.readbyqxmd.com/read/27318585/management-of-penetrating-abdominal-and-thoraco-abdominal-wounds-a-retrospective-study-of-186-patients
#15
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
https://www.readbyqxmd.com/read/27260640/hospital-care-in-severe-trauma-initial-strategies-and-life-saving-surgical-procedures
#16
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
https://www.readbyqxmd.com/read/27211954/nonoperative-damage-control-the-use-of-extracorporeal-membrane-oxygenation-in-traumatic-bronchial-avulsion-as-a-bridge-to-definitive-operation
#17
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
https://www.readbyqxmd.com/read/27194248/thinking-outside-the-box-re-evaluating-the-approach-to-penetrating-cardiac-injuries
#18
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
https://www.readbyqxmd.com/read/27192469/identifying-potential-utility-of-reboa-an-autopsy-study
#19
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
https://www.readbyqxmd.com/read/27172156/emerging-endovascular-therapies-for-non-compressible-torso-hemorrhage
#20
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
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