The prevalence of EMS utilisation in OHCA at Siriraj Hospital was very low. This may affect the outcomes of patients with OHCA. Improving the EMS system by publicity to increase public awareness and providing life-support education nationwide may improve outcomes of patients with OHCA in Thailand.

No abstract

- Background: To demonstrate how to perform successful REBOA/ABO in extreme elderly patient - Materials and methods: A case report - Results: A 86-year old male, he was struck by car and transferred to Level I Trauma center at Siriraj hospital after injury for 30 minutes. Arrival clinical signs were coma and hypotension, lowest SBP was 50 mmHg. Primary survey found unstable pelvic fracture and severe head injury. We did REBOA at Zone I via left common femoral artery which aim to do partial balloon technique by inflation with 15-18 mL and arterial line monitoring for goal SBP around 100-120 mmHg due to his extreme age and associated traumatic brain injury. After CT scan showed no intra-abdominal injury, we did reposition the balloon to zone III under fluoroscopy. Unexpectedly, during deflation the balloon before removal, we found fresh blood through the balloon port, then ruptured balloon was suspected and confirmed with aortography. We immediately converted to remove by open technique due to balloon was failed to shrinkage through 7-Fr sheath. We reviewed the CT scan was shown calcified plaque along aorta and arteries which could be the cause of ruptured balloon. Throughout all procedures to stop bleeding which are pelvic external fixation, preperitoneal pelvic packing and embolization at right internal iliac artery, patient was given PRC only 4 units and no inotropic support to stabilizing patient. Total inflation time was 167 minutes with partial and intermittent REBOA technique. ICU Admission lab showed normal renal and liver function. - Conclusion : To perform ABO/REBOA in extreme elderly trauma patient, the partial balloon technique with goal SBP to balance between associated injury in polytrauma patient is very essential. The specific concern in this group would be related with reserve function and the changing of vascular access. Techniques for detection and solving the uneventful conditions should be prepared and learnt to successfully save the elderly patient.

Background To develop a perfused cadaveric model for trauma surgery simulation, and to evaluate its efficacy in trauma resuscitation advanced surgical skills training. Methods Fourteen fourth-year general surgery residents attended this workshop at Siriraj Hospital (Bangkok, Thailand). Inflow and outflow cannulae and a cardiopulmonary bypass pump were used to create the perfusion circuit. Inflow was achieved by cannulating the right common carotid artery, and outflow by cannulation of both the right common femoral artery and the internal jugular vein. Arterial line monitoring was used to monitor resuscitation response and to control perfusion pressure. The perfusion solution comprised saline solution mixed 1:1 with glycerol (50%) and water with red food dye added. Advanced surgical skills during life-threatening injuries and damage control resuscitation operations were practiced starting from the airway to the neck, chest, peripheral vessels, abdomen, and pelvis. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also practiced. Post-workshop survey questions were grouped into three categories, including comparison with previous training methods; the realism of anatomical correlation and procedures; and, satisfaction, safety, and confidence. All questions and tasks were discussed among all members of the development team, and were agreed upon by at least 90% of experts from each participating medical specialty/subspecialty. Results The results of the three main groups of post-workshop survey questions are, as follows: (1) How the training compared with previous surgical training methods—mean score: 4.26/5.00, high score: 4.73/5.00; (2) Realism of anatomical correlation and procedures—mean score: 4.03/5.00, high score: 4.60/5.00; and, (3) Satisfaction, safety, and confidence—mean score: 4.24/5.00, high score: 4.47/5.00. Conclusion The developed perfused cadaveric model demonstrated potential advantages over previously employed conventional surgical training techniques for teaching vascular surgery at our center as evidenced by the improvement in the satisfaction scores from students attending perfused cadaveric training compared to the scores reported by students who attended earlier training sessions that employed other training techniques. Areas of improvement included ‘a more realistic training experience’ and ‘improved facilitation of decision-making and damage control practice during trauma surgery’.