Hybrid emergency room system improves timeliness of angioembolization for pelvic fracture

Ito, Kaori; Nagao, Tsuneatsu; Tsunoyama, Taichiro; Kono, Kaori; Tomonaga, Ayumi; Nakazawa, Kenji; Chiba, Hiroto; Kondo, Hiroshi; Sugawara, Toshimasa; Yamamoto, Masayoshi; Yokoyama, Tetsuji; Zako, Ryusei; Suzuki, Akiyoshi; Inui, Shigeru; Miyake, Yoshihiro; Sakamoto, Tetsuya; Fujita, Takashi

doi:10.1097/ta.0000000000002544

Cited by 27 publications

(31 citation statements)

References 12 publications

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“…The creation of rapid response teams led by trauma surgery and IR, and the use of hybrid operative rooms (HORs) where available, has revolutionized the treatment of many traumatic injuries. 3,4 Many patients who were treated with surgery in the past can now be treated with expedited embolization even in hemodynamically unstable situations. Also, embolization can be a lifesaving procedure for those patients who are having uncontrollable bleeding during surgery.…”

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confidence: 99%

Embolization in Trauma: Review of Basic Principles and Techniques

Lopera

2021

Semin intervent Radiol

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Trauma is the leading cause of death in patients younger than 45 years. Over the last decade, there has been a progressive paradigm shift toward a nonoperative management of many blunt and penetrating injuries, placing interventional radiology in the forefront in this critical field. Transcatheter embolization is an established technique that plays a significant role in the modern treatment of traumatic injuries of the extremities, pelvis, and solid organs. The purpose of this article is to review the updated principles and techniques used in transcatheter embolization in trauma.

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confidence: 99%

Embolization in Trauma: Review of Basic Principles and Techniques

Lopera

2021

Semin intervent Radiol

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“…Regarding trauma care, several studies have reported that hybrid ER use was significantly associated with decreased time to diagnosis, improved definitive treatment, and reduced mortality. [11][12][13] The hybrid ER may also be utilized for non-trauma patients requiring a CT scan, angiography, and surgical procedures. From the perspective of life-threatening hemorrhagic shock, rAAA is similar to trauma.…”

Section: Discussionmentioning

confidence: 99%

Hybrid emergency room management of a ruptured abdominal aortic aneurysm

Murai¹,

Matsumoto²,

Egawa³

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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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.

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“…Lastly, hybrid operating room systems have to be mentioned. In multiple studies, hybrid operating rooms have been shown to improve the management and workflow in patients with severe pelvic ring injuries (36)(37)(38). Ito and colleagues recently demonstrated that the time from admission to angio-embolization was significantly shorter in the hybrid operating room group.…”

Section: Discussionmentioning

confidence: 99%

“…Ito and colleagues recently demonstrated that the time from admission to angio-embolization was significantly shorter in the hybrid operating room group. At our institution (and likely in the vast majority of trauma centers worldwide), hybrid operating room systems are currently not available, however, it would clearly pose a significant advantage in the management of these patients (38). The most commonly reported arteries that require embolization in patients with pelvic ring injuries are the internal iliac artery in approximately 67%, unnamed branches of the internal iliac artery (17%), the superior gluteal artery (4%), the obturator artery (4%), and the internal pudendal artery (3%) (39).…”

Section: Discussionmentioning

confidence: 99%

Secondary Angio-Embolization After Emergent Pelvic Stabilization and Pelvic Packing Is a Safe Option for Patients With Persistent Hemorrhage From Unstable Pelvic Ring Injuries

et al. 2020

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Introduction: In patients with severe pelvic ring injuries, exsanguination still is the leading cause of death in the early post-injury phase. While mechanical pelvic ring stabilization and pre-peritoneal pelvic packing are mainly addressing venous bleeding, angio-embolization aims to control arterial bleeding. The goal of the present study was to evaluate the rate of postoperative angio-embolization after mechanical pelvic ring injury stabilization and pre-peritoneal pelvic packing. Bleeding sources detected in the angiography and the patient's outcome were investigated.Patients and Methods: Retrospective observational cohort study at a single academic level I trauma center, reviewing all patients with pelvic ring injuries admitted from 01/2010 to 12/2019. Patients with emergent mechanical pelvic ring stabilization (supraacetabular external fixator and/or pelvic C-clamp) and direct pre-peritoneal pelvic packing were further analyzed. Patients that underwent postoperative angio-embolization were compared with those that did not. All postoperative angio-embolizations were evaluated with regards to bleeding sources and type of embolization.Results: During the study period, a total of 39 patients required immediate mechanical pelvic stabilization and direct pre-peritoneal pelvic packing. Of these, 12 patients (30.8%) underwent a postoperative angio-embolization. The following vessels were identified as bleeding sources: superior gluteal artery (n = 6), obturator artery (n = 2), internal pudendal artery (n = 2), unnamed branches of the internal iliac artery (n = 3). A selective embolization was successful in 11 patients; in 1 patient, an unilateral complete occlusion of the internal iliac artery was performed to control the bleeding. Mean time from hospital admission to the surgical procedure was 52.8 ± 14.7 min and the mean time from admission to angio-embolization was 189.1 ± 55.5 min. The in-hospital mortality rate of patients with angio-embolization was 25.0% (n = 3). Of these, 2 patients died due to multiple organ failure and 1 patient due to severe head injury.Conclusion: Secondary angio-embolization after external pelvic fixation and pre-peritoneal pelvic packing was effective in controlling ongoing bleeding. The most frequently detected bleeding vessel was the superior gluteal artery, which is difficult to surgically address, further highlighting the importance of angio-embolization in the management algorithm.

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Hybrid emergency room system improves timeliness of angioembolization for pelvic fracture

Cited by 27 publications

References 12 publications

Embolization in Trauma: Review of Basic Principles and Techniques

Embolization in Trauma: Review of Basic Principles and Techniques

Hybrid emergency room management of a ruptured abdominal aortic aneurysm

Secondary Angio-Embolization After Emergent Pelvic Stabilization and Pelvic Packing Is a Safe Option for Patients With Persistent Hemorrhage From Unstable Pelvic Ring Injuries

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