An online survey of non-compressible torso hemorrhage: training is needed

Zhang, Huayu; Yu, Guo; Huang, Xiaoying; Li, Yang; Zhang, Lianyang

doi:10.5847/wjem.j.1920-8642.2022.069

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…The same research team further explored doctors’ cognitive level of NCTH, as well as attitudes and preferences towards continuing training after completing a self-administered study program [ 68 ]. Notably, the correct answer rate of NCTH definition (20.0%), as well as the involved organs (33.9%) and vessels (37.2%) was still similar to the previous study after completing the handout reading.…”

Section: Torso Hemorrhage and Cognition Of Medical Staff: Time To Bre...mentioning

confidence: 99%

“…Abandoning the old-school thinking that TH cannot be controlled via external compression and taking full advantage of tourniquets in emergent TH control is practical to improve the survival benefit and ultimately achieve the best practice in prehospital trauma care. However, the misunderstanding of NCTH’s definition [ 67 , 68 ], especially the literal understanding of the word “noncompressible”, which not only reflects the necessity and urgency of NCTH-related training, but also indicates the relative mismatch between NCTH naming and current development of hemostatic technology.…”

Section: The Intrinsic Philosophy Of Torso Hemorrhage: Who Am I and W...mentioning

confidence: 99%

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Torso hemorrhage: noncompressible? never say never

Zhang,

Zhang

2024

Eur J Med Res

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Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH’ (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.

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Section: Torso Hemorrhage and Cognition Of Medical Staff: Time To Bre...mentioning

confidence: 99%

Section: The Intrinsic Philosophy Of Torso Hemorrhage: Who Am I and W...mentioning

confidence: 99%

Torso hemorrhage: noncompressible? never say never

Zhang,

Zhang

2024

Eur J Med Res

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“…Non-compressible torso hemorrhage (NCTH) remains a preventable cause of death from trauma. [1] Currently, early systemic fluid resuscitation or blood transfusion combined with effective hemostatic measures is often recommended to stabilize the physiological state of NCTH patients. [2] Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a readily attainable and eff ective early in-hospital and pre-hospital intervention for provisionally controlling hemorrhage from NCTH.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of partial and complete resuscitative endovascular balloon occlusion of the aorta in the hemorrhagic shock model of liver injury

Shan,

Zhao,

et al. 2024

World Journal of Emergency Medicine

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BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) can temporarily control traumatic bleeding. However, its prolonged use potentially leads to ischemiareperfusion injury (IRI). Partial REBOA (pREBOA) can alleviate ischemic burden; however, its security and eff ectiveness prior to operative hemorrhage control remains unknown. Hence, we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS: Twenty Landrace pigs were randomized into control (no aortic occlusion) (n=5), intervention with complete REBOA (cREBOA) (n=5), continuous pREBOA (C-pREBOA) (n=5), and sequential pREBOA (S-pREBOA) (n=5) groups. In the cREBOA and C-pREBOA groups, the balloon was infl ated for 60 min. The hemodynamic and laboratory values were compared at various observation time points. Tissue samples immediately after animal euthanasia from the myocardium, liver, kidneys, and duodenum were collected for histological assessment using hematoxylin and eosin staining. RESULTS:Compared with the control group, the survival rate of the REBOA groups was prominently improved (all P<0.05). The total volume of blood loss was markedly lower in the cREBOA group (493.14±127.31 mL) compared with other groups (P<0.01). The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups (P<0.05). At 120 min, the S-pREBOA group showed higher alanine aminotransferase (P<0.05) but lower blood urea nitrogen compared with the cREBOA group (P<0.05). CONCLUSION:In this trauma model with liver injury, a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure, despite persistent hemorrhage. Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures, and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

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