Nonoperative management with angioembolization for blunt abdominal solid organ trauma in hemodynamically unstable patients: a systematic review and meta-analysis

Tan, Taifa; Luo, Yong; Hu, Jun; Li, Fang; Fu, Yong

doi:10.1007/s00068-022-02054-2

Cited by 7 publications

(8 citation statements)

References 39 publications

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“…Interventional radiology angioembolization has become integral to trauma care but requires a specialized, multidisciplinary team approach (Chehab et al., 2020). The combination of angiography and embolization of bleeding arterial vessels has emerged as an exceptional treatment method to manage vascular lesions in solid organ and pelvic injuries (Aoki et al., 2021; Devaney et al., 2022; Kim et al., 2021; Tan et al., 2023). Advances in CT imaging, more efficient scanning times, and improved image quality have improved the specificity of care (Gilyard et al., 2020).…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly injured solid organs in blunt trauma are the spleen and liver, with liver hemorrhage serving as a leading cause of mortality. However, angioembolization in blunt abdominal trauma has proven safe and decreased the mortality rate from 50% to 10%–20% and has become the mainstay of treatment in hepatic trauma (Chehab et al., 2020; Gilyard et al., 2020; Tan et al., 2023).…”

Section: Discussionmentioning

confidence: 99%

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Improving Time to Angioembolization for Trauma Care: Novel Smartphone Application

Miles,

Quinlan

2024

Journal of Trauma Nursing

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BACKGROUND: Timely angiographic embolization of abdominopelvic injuries is a hallmark of a high-functioning trauma center. Yet, the process depends on the timely mobilization of interventional radiology staff. Smartphone technology to notify and mobilize staff may be a viable option. OBJECTIVE: To describe the incorporation of a smartphone application into our trauma workflow process previously developed for stroke care. METHODS: In 2022, our Level I trauma center implemented a smartphone application with three simultaneously occurring functions: (a) high-definition image viewing on the phone; (b) text messaging thread for all parties; and (c) a single-call activation system for staff mobilization. The application was initially developed to notify interventional radiologists of large-vessel occlusions in victims of stroke and, at our request, was modified to fit our trauma workflow process. The smartphone application company developed a new program, installed the application on trauma service smartphones, and provided educational in-services over a 1-month period. The application was then integrated into our trauma workflow process. RESULTS: The trauma surgeon and the interventional radiologist can now simultaneously view high-definition images on their smartphones. Text messages are accessible to all team members. The staff is notified and mobilized with the singlecall smartphone application, preventing the placing and returning of phone calls. CONCLUSION: Smartphone technology enhances timely interventional radiology staff response for hemorrhagic patients requiring emergent angioembolization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving Time to Angioembolization for Trauma Care: Novel Smartphone Application

Miles,

Quinlan

2024

Journal of Trauma Nursing

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“…A recent study using a nationwide dataset in Japan revealed no significant differences in survival between laparotomy and angioembolization as an initial hemorrhagic control treatment if patients with solid organ injuries responded to the initial resuscitation [15]. Another systematic review also noted that angioembolization could potentially be considered in hemodynamically unstable patients with solid organ injury if a patient responded to rapid fluid resuscitation [16]. Our results suggest that most patients in the matched cohort were started on a blood transfusion before undergoing hemorrhage control procedures (i.e., splenectomy or SAE) and underwent a total of 2–3 units of PRBC within 4 h. Although future studies are still warranted for validation, it may be reasonable to consider a liberal use of blood products for the initial resuscitation and evaluate responses in hemodynamic status before making a surgical decision on splenectomy.…”

Section: Discussionmentioning

confidence: 99%

Angioembolization for Isolated Severe Blunt Splenic Injuries with Hemodynamic Instability: A Propensity Score Matched Analysis

Aoki,

Matsumoto,

Abe

et al. 2023

World j. surg.

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Background This study aimed to compare patient outcomes after splenic angioembolization (SAE) or splenectomy for isolated severe blunt splenic injury (BSI) with hemodynamic instability, and to identify potential candidates for SAE. Methods Adult patients with isolated severe BSI (Abbreviated Injury Scale [AIS] 3-5) and hemodynamic instability between 2013 and 2019 were identified from the American College of Surgeons Trauma Quality Improvement (ACS TQIP) database. Hemodynamic instability was defined as an initial systolic blood pressure (SBP) \90 mmHg, heart rate (HR) [120 bpm, or lowest SBP \90 mmHg within 1 h after admission, with C1 unit of blood transfused within 4 h after admission. In-hospital mortality was compared between splenectomy and SAE groups using 2:1 propensityscore matching. The characteristics of unmatched and matched splenectomy patients were also compared. Results A total of 478 patients met our inclusion criteria (332 splenectomy, 146 SAE). After propensity-score matching, 166 splenectomy and 83 SAE patients were compared. Approximately 85% of propensity-score matched patients sustained AIS 3/4 injuries, and 50% presented with normal SBP and HR before becoming hemodynamically unstable. The median time to intervention (splenectomy or SAE) was 137 min (interquartile range 94-183). Inhospital mortality between splenectomy and SAE groups was not significantly different (5.4% vs. 4.8%, p = 1.000). More than half of unmatched patients in the splenectomy group sustained AIS 5 injuries and presented with initially unstable hemodynamics. The median time to splenectomy in such patients was significantly shorter than in matched splenectomy patients (67 vs. 132 min, p \ 0.001). Conclusion Splenectomy remains the mainstay of treatment for patients with AIS 5 BSI who present to hospital with hemodynamic instability. However, SAE might be a feasible alternative for patients with AIS 3/4 injuries.

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“…Repeated measurements should be performed as an initially normal Hb might conceal severe bleeding. Critical patients with an obvious bleeding source should undergo immediate life-saving procedures including surgery or angiographic embolization [20]). A whole-body computed tomography (CT) scan with contrast agent is the gold standard to detect bleeding and should be performed as early as possible during in-hospital trauma management.…”

Section: Initial Emergency Department Management Of Major Traumatic B...mentioning

confidence: 99%

Management of major bleeding for anticoagulated patients in the Emergency Department: an European experts consensus statement

Backus

Beyer‐Westendorf

Body

et al. 2023

European Journal of Emergency Medicine

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An increasing number of patients presenting to the emergency department (ED) with life-threatening bleeding are using oral anticoagulants, such as warfarin, Factor IIa and Factor Xa inhibitors. Achieving rapid and controlled haemostasis is critically important to save the patient’s life. This multidisciplinary consensus paper provides a systematic and pragmatic approach to the management of anticoagulated patients with severe bleeding at the ED. Repletion and reversal management of the specific anticoagulants is described in detail. For patients on vitamin K antagonists, the administration of vitamin K and repletion of clotting factors with four-factor prothrombin complex concentrate provides real-time ability to stop the bleeding. For patients using a direct oral anticoagulant, specific antidotes are necessary to reverse the anticoagulative effect. For patients receiving the thrombin inhibitor dabigatran, treatment with idarucizamab has been demonstrated to reverse the hypocoagulable state. For patients receiving a factor Xa inhibitor (apixaban or rivaroxaban), andexanet alfa is the indicated antidote in patients with major bleeding. Lastly, specific treatment strategies are discussed in patients using anticoagulants with major traumatic bleeding, intracranial haemorrhage or gastrointestinal bleeding.

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Nonoperative management with angioembolization for blunt abdominal solid organ trauma in hemodynamically unstable patients: a systematic review and meta-analysis

Cited by 7 publications

References 39 publications

Improving Time to Angioembolization for Trauma Care: Novel Smartphone Application

Improving Time to Angioembolization for Trauma Care: Novel Smartphone Application

Angioembolization for Isolated Severe Blunt Splenic Injuries with Hemodynamic Instability: A Propensity Score Matched Analysis

Management of major bleeding for anticoagulated patients in the Emergency Department: an European experts consensus statement

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