Hybrid emergency room management of a ruptured abdominal aortic aneurysm

Abstract

Patients with a ruptured abdominal aortic aneurysm (rAAA) still have high mortality. Rapid diagnosis and treatment are vital for improving survival outcomes. rAAA management has evolved regarding these factors. We have reported the case of a 70-year-old man with an rAAA that was rapidly diagnosed and treated in a hybrid emergency room (ER). A hybrid ER is an integrated ER capable of computed tomography scanning, interventional radiology, and surgery in one place. In the present case, the door-to-intervention time was 35 minutes. The use of hybrid ERs has the potential to enhance the speed and quality of diagnostic and definitive treatment of rAAAs.

Hybrid trauma service: on the leading edge of damage control

“…A cost-effectiveness study regarding the implementation of hybrid rooms was conducted in Japanese hospitals, estimating a benefit of 1.03 quality-adjusted life years (QALYs) with an incremental cost-effectiveness ratio (ICER) of US$35,552 per QALY. The analysis estimated that the implementation of an hybrid room has a probability of 79.3% of being cost-effective 19 , 20 .…”

“…Un estudio desarrollado en hospitales japoneses evaluó la costó-efectividad de una sala hibrida reportando que esta estrategia puede generar una ganancia de 1.03 años de vida ajustado QALY (quality-adjusted life year) y una relación de costo-efectividad incremental ICER (incremental cost-effectiveness ratio) de $35.552 dólares por QALY. Se estimo que la implementación de la sala hibrida tendría una probabilidad de ser costo-efectivo del 79.3% 19 , 20 .…”

Hybrid emergency room: Installation, establishment, and innovation in the emergency department

“…Kinoshita et al was the first to report on the effectiveness of the installation of a hybrid ER in the trauma resuscitation on clinical outcomes and prognosis achieved the innovative trauma workflow. 10 In their historical controlled study, time to initiation of CT (Conventional group 26 [21][22][23][24][25][26][27][28][29][30][31][32] vs. hybrid ER 11 [8][9][10][11][12][13][14][15][16] min; p < 0.0001) and an emergency procedure (68 [51-85] vs. 47 [37-57] min; p < 0.0001) were both shorter in the hybrid ER group. A significant association was found between the hybrid ER and decreased mortality (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.29-0.85; p = 0.011) and reduced deaths from exsanguination (aOR, 0.17; 95% CI, 0.06-0.47; p = 0.001).…”

“…A significant association was found between the hybrid ER and decreased mortality (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.29-0.85; p = 0.011) and reduced deaths from exsanguination (aOR, 0.17; 95% CI, 0.06-0.47; p = 0.001). The times to initiation of CT and emergency bleeding control procedures were also both shorter in the hybrid ER group versus the Conventional group (11 [8-16] vs. 26 [21][22][23][24][25][26][27][28][29][30][31][32] The first retrospective observational study on blood transfusion amounts during resuscitation in the hybrid ER was reported by Watanabe et al The amount of blood transfused was significantly lower in the hybrid ER versus nonhybrid ER group (whole blood: 8 vs. 14 units, p = 0.004; red blood cells: 2 vs. 6 units, p = 0.012; fresh frozen plasma: 6 vs. 9 units, p = 0.021). 29 This difference remained after propensity score matching (whole blood: 6 [4-16.5] vs. 28 units, p = 0.015; red blood cells: 2 [0-8.5] vs. 8 [2.75-26.5] units, p = 0.020; fresh frozen plasma: 6 [3.5-7.5] vs. 18 [5.5-27] units, p = 0.057).…”

“…In contrast, both rapid, accurate diagnosis and definitive treatment of a rAAA can be achieved in the single hybrid ER room. In the successfully treated case of a patient with an rAAA, Murai et al reported the rapid diagnosis and treatment of the condition in a hybrid ER, for which the door‐to‐intervention time was 35 min 24 . Their report indicated the potential of the hybrid ER to enhance diagnostic speed and quality and definitive treatment of rAAA, which can lead to optimal outcomes.…”