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  • 1.
    Ahl, Rebecka
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden ; .
    Thelin, Eric Peter
    Department of Clinical Neuroscience, Karolinska Institutet Solna, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro universitet, Institutionen för medicinska vetenskaper. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Bellander, Bo Michael
    Department of Clinical Neuroscience, Karolinska Institutet Solna, Stockholm, Sweden.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Talving, Peep
    Department of Surgery, Tartu University Hospital, Tartu, Estonia.
    Mohseni, Shahin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
    β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study2017Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 43, nr 6, s. 783-789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.

    METHODS: Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.

    RESULTS: 362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days, p < 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01-6.03, p = 0.03).

    CONCLUSION: Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.

  • 2.
    Borger van der Burg, B. L. S.
    et al.
    Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
    van Dongen, Thijs T. C. F.
    Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.
    Morrison, J. J.
    R. Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA.
    Hedeman Joosten, P. P. A.
    Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
    DuBose, J. J.
    Division of Vascular Surgery, David Grant Medical Center, Travis AFB, California, USA.
    Hörer, Tal M.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery.
    Hoencamp, R.
    Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands; Division of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
    A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination2018Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, nr 4, s. 535-550Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    BACKGROUND: Circulatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.

    METHODS: Systematic review and meta-analysis (1900-2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords "aortic balloon occlusion", "aortic balloon tamponade", "REBOA", and "Resuscitative Endovascular Balloon Occlusion" in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.

    RESULTS: A total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.

    CONCLUSION: REBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.

  • 3.
    Hörer, Tal M.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital and University, Örebro, Sweden; Department of General Surgery, Örebro University Hospital and University, Örebro, Sweden.
    Resuscitative endovascular balloon occlusion of the aorta (REBOA) and endovascular resuscitation and trauma management (EVTM): a paradigm shift regarding hemodynamic instability2018Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, nr 4, s. 487-489Artikel i tidskrift (Refereegranskat)
  • 4.
    Hörer, Tal M.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Skoog, Per
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden.
    A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review2016Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 42, nr 5, s. 585-592Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm.

    We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma.

    A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented.

    Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients.

    EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.

  • 5.
    Manzano-Nunez, Ramiro
    et al.
    Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia; Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia.
    Herrera-Escobar, Juan Pablo
    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard T.H Chan School of Public Health, Boston MA, USA.
    DuBose, Joseph
    R Adams Cowley Shock Trauma Center, Baltimore MD, USA.
    Hörer, Tal M.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Department of General Surgery, Örebro University Hospital, Örebro, Sweden.
    Galvagno, Samuel
    Department of Anesthesiology, R Adams Cowley Shock Trauma Center, Baltimore MD, USA.
    Orlas, Claudia Patricia
    Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia; Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia.
    Parra, Michael W.
    Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale FL, USA.
    Coccolini, Federico
    Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
    Sartelli, Massimo
    Department of Surgery, Macerata Hospital, Macerata, Italy.
    Falla-Martinez, Juan Camilo
    Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia.
    García, Alberto Federico
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia.
    Chica, Julian
    Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia; Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia.
    Naranjo, Maria Paula
    Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia.
    Sanchez, Alvaro Ignacio
    Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia; Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia.
    Salazar, Camilo Jose
    School of Medicine, Universidad ICESI, Cali, Colombia.
    Calderón-Tapia, Luis Eduardo
    Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia.
    Lopez-Castilla, Valeria
    School of Medicine, Universidad ICESI, Cali, Colombia.
    Ferrada, Paula
    Surgical and Trauma Intensive Care Unit, VCU Health System, Virginia Commonwealth University, Richmond VA, USA.
    Moore, Ernest E.
    Department of Surgery, Trauma Research Center, University of Colorado, Denver CO, USA.
    Ordonez, Carlos A.
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia.
    Could resuscitative endovascular balloon occlusion of the aorta improve survival among severely injured patients with post-intubation hypotension?2018Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, nr 4, s. 527-533Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Current literature shows the association of post-intubation hypotension and increased odds of mortality in critically ill non-trauma and trauma populations. However, there is a lack of research on potential interventions that can prevent or ameliorate the consequences of endotracheal intubation and thus improve the prognosis of trauma patients with post-intubation hypotension. This review paper hypothesizes that the deployment of REBOA among trauma patients with PIH, by its physiologic effects, will reduce the odds of mortality in this population. The objective of this paper is to review the current literature on REBOA and post-intubation hypotension, and, furthermore, to provide a rational hypothesis on the potential role of REBOA in severely injured patients with post-intubation hypotension.

  • 6.
    Mohseni, Shahin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Division of Trauma and Emergency Surgery, Department of Surgery.
    Ivarsson, John
    Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ahl, Rebecka
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Dogan, Sinan
    Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Saar, Sten
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallin, Estonia.
    Reinsoo, Arvo
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallin, Estonia.
    Sepp, Teesi
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallin, Estonia.
    Isand, Karl-Gunnar
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallin, Estonia.
    Garder, Edvard
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallin, Estonia.
    Kaur, Ilmar
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallin, Estonia.
    Ruus, Heiti
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallin, Estonia.
    Talving, Peep
    Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, Tallin, Estonia.
    Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach2019Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 45, nr 2, s. 337-342Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The timing and optimal method for common bile duct (CBD) clearance and laparoscopic cholecystectomy remains controversial. Several different approaches are available in clinical practice. The current study presents the experience of two European hospitals of simultaneous laparoscopic cholecystectomy (LC) and intra-operative endoscopic retrograde cholangiopacreatography (IO-ERCP) done by surgeons.

    Methods: Retrospective analysis of all consecutive patients subjected to LC+IO-ERCP during their index admission between 4/2014 and 9/2016. Data accrued included patient demographics, laboratory markers, operation time (min) reported as mean (SD) and hospital length of stay (LOS) reported as median (lower quartile, upper quartile).

    Results: During the 29-month study, a total of 201 consecutive LC+IO-ERCPs were performed. The mean age of patients was 55 +/- 19years and 67% were female. The mean intervention time was 105 +/- 44min. The total LOS was 4 (3, 7) days and the post-operative LOS was 2 (1, 3)days. A total of 6 (3%) patients experienced post-interventional pancreatitis and two (1%) patients suffered a Strasberg type A bile leak. All patients were successfully discharged.

    Conclusion: Simultaneous LC+IO-ERCP is associated with few complications. Further studies investigating cost-benefit and patient satisfaction are warranted.

  • 7.
    Reva, V. A.
    et al.
    Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
    Matsumura, Y.
    R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore MD, United States; Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
    Hörer, Tal M.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Sveklov, D. A.
    Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
    Denisov, A. V.
    Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
    Telickiy, S. Y.
    Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
    Seleznev, A. B.
    Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
    Bozhedomova, E. R.
    Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
    Matsumoto, J.
    Departments of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Sugao Kawasaki, Japan; Department of Radiology, National Hospital Organization Disaster Medical Center, Tachikawa, Japan.
    Samokhvalov, I. M.
    Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
    Morrison, J. J.
    Department of Vascular Surgery, South Glasgow University Hospital, Glasgow, United Kingdom; The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
    Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?2018Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, nr 4, s. 511-518Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock.

    Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage.

    Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals.

    In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.

  • 8.
    Sadeghi, Mitra
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Department of Cardiothoracic and Vascular Surgery Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden .
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Skoog, Per
    Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Idoguchi, Koji
    Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan.
    Kon, Yuri
    Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan.
    Ishida, Tokiya
    Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
    Matsumara, Y.
    Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; R Adams Cowley Shock Trauma Center, University of Maryland, College Park MD, United States.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor A.
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, Russian Federation; Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russian Federation.
    Maszkowski, M.
    Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Bersztel, Adam
    Västmanlands Hospital, Västerås, Sweden; Department of Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Caragounis, Eva Corina
    Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Falkenberg, Mårten P.
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Handolin, Lauri E.
    Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Kessel, Boris J.
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Coccolini, Federico
    Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Ansaloni, Luca
    Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Madurska, Marta J.
    Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
    Morrison, Jonathan James
    Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
    Hörer, Tal Martin
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry2018Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, nr 4, s. 491-501Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary stabilization of patients with non-compressible torso hemorrhage. This technique has been increasingly used worldwide during the past decade. Despite the good outcomes of translational studies, clinical studies are divided. The aim of this multicenter-international study was to capture REBOA-specific data and outcomes.

    METHODS: REBOA practicing centers were invited to join this online register, which was established in September 2014. REBOA cases were reported, both retrospective and prospective. Demographics, injury patterns, hemodynamic variables, REBOA-specific data, complications and 30-days mortality were reported.

    RESULTS: Ninety-six cases from 6 different countries were reported between 2011 and 2016. Mean age was 52 ± 22 years and 88% of the cases were blunt trauma with a median injury severity score (ISS) of 41 (IQR 29-50). In the majority of the cases, Zone I REBOA was used. Median systolic blood pressure before balloon inflation was 60 mmHg (IQR 40-80), which increased to 100 mmHg (IQR 80-128) after inflation. Continuous occlusion was applied in 52% of the patients, and 48% received non-continuous occlusion. Occlusion time longer than 60 min was reported as 38 and 14% in the non-continuous and continuous groups, respectively. Complications, such as extremity compartment syndrome (n = 3), were only noted in the continuous occlusion group. The 30-day mortality for non-continuous REBOA was 48%, and 64% for continuous occlusion.

    CONCLUSIONS: This observational multicenter study presents results regarding continuous and non-continuous REBOA with favorable outcomes. However, further prospective studies are needed to be able to draw conclusions on morbidity and mortality.

  • 9.
    Sönnerqvist, Caroline
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Olivecrona, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Anaesthesiology and Intensive Care, Section for Neurosurgery.
    Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children2020Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines.

    METHODS: We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study" by Kuppermann et al. (Lancet 374(9696):1160-1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted.

    RESULTS: We analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group.

    CONCLUSION: Children with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

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