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  • 1.
    Bukur, M.
    et al.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States; Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Department of Acute Care Surgery, Los Angeles County, Los Angeles CA, United States; University of Southern California Medical Center, Los Angeles CA, United States.
    Ley, E.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States.
    Salim, A.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States.
    Margulies, D.
    Division of Trauma and Surgical Critical Care, Department of Surgery, Cedars Sinai Medical Center, Los Angeles CA, United States.
    Talving, P.
    Department of Acute Care Surgery, Los Angeles County, Los Angeles CA, United States; University of Southern California Medical Center, Los Angeles CA, United States.
    Demetriades, D.
    Department of Acute Care Surgery, Los Angeles County, Los Angeles CA, United States; University of Southern California Medical Center, Los Angeles CA, United States.
    Inaba, K.
    Department of Acute Care Surgery, Los Angeles County, Los Angeles CA, United States; University of Southern California Medical Center, Los Angeles CA, United States.
    Efficacy of beta-blockade after isolated blunt head injury: Does race matter? (vol 72, pg 1013, 2012)2012In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 72, no 6, p. 1725-1725Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several retrospective clinical studies and recent prospective animal models demonstrate improved outcomes with beta-blocker administration after isolated blunt head injury. However, no investigations to date have examined the influence of race on the potential therapeutic effectiveness of these medications. Our hypothesis was that mortality benefits associated with beta-blocker exposure after isolated blunt head injury varies based on ethnicity.

    METHODS: The trauma registry and the surgical intensive care unit (ICU) databases of an academic Level I trauma center were used to identify all patients sustaining blunt head injury requiring ICU admission from July 1998 to December 2009. Patients sustaining major associated extracranial injuries (Abbreviated Injury Scale [AIS] score ≥3 in any body region) were excluded. Patient demographics, injury profile, Injury Severity Score, and beta-blocker exposure were abstracted. The primary outcome evaluated was in-hospital mortality stratified by ethnicity.

    RESULTS: During the 11-year study period, 3,750 patients were admitted to the Los Angeles County + University of Southern California Medical Center trauma ICU because of blunt trauma. Of these, 65% (n = 2,446) had an “isolated” head injury. When stratified by race, most patients were Hispanics (60%), followed by Whites (21%), Asians (11%), and African Americans (8%). After adjusting for confounding variables with multivariate regression, only those of Asian and Hispanic descent demonstrated significantly improved outcomes associated with beta-blocker administration.

    CONCLUSIONS: Our results indicate that beta-blockade after traumatic brain injury may not benefit all races equally. Further prospective research is necessary to assess this discrepancy in treatment benefit and explore other possible therapeutic interventions.

    LEVEL OF EVIDENCE: III, therapeutic study; II, prognostic study.

  • 2.
    Ljungqvist, Olle
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Kahn, A
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Ware, James
    Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Evidence of increased gluconeogenesis during hemorrhage in fed and 24-hour food-deprived rats1989In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 29, no 1, p. 87-90Article in journal (Refereed)
    Abstract [en]

    Food withdrawal 24 hr before hemorrhage has been shown to increase experimental post-hemorrhage mortality, and survival is associated with the degree of hyperglycemia. Lack of hyperglycemic response has been attributed to depleted glycogen reserves after 24-hr food withdrawal. To investigate the effect of short-term food deprivation on glucose metabolism during hemorrhagic stress, glucose production (rate of appearance, Ra), glucose uptake (rate of disappearance, Rd), glucose clearance, and glucose recycling were investigated in fed and 24-hr food-deprived rats under basal conditions, and during hemorrhagic hypotension using 3-H3-U-C14-glucose. During hemorrhage, blood glucose levels were higher in fed rats. Hemorrhage induced a decrease in glucose clearance irrespective of nutritional state in both 24-hr starved animals and rats in the postprandial state. Calculated glucose recycling increased in both groups after hemorrhage. The results indicate that hemorrhagic stress induces a rapid increase in gluconeogenesis, as reflected by increased glucose recycling.

  • 3.
    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.
    Orlas, Claudia P.
    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 P.
    Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health. Boston MA, USA.
    Galvagno, Samuel
    R Adams Cowley Shock Trauma Center, Baltimore MD, USA.
    DuBose, Joseph
    R Adams Cowley Shock Trauma Center, Baltimore MD, USA.
    Melendez, Juan J.
    Trauma and Acute Care Surgery Fellowship, Department of Surgery, Universidad del Valle, Cali, Colombia.
    Serna, Jose J.
    Trauma and Acute Care Surgery Fellowship, Department of Surgery, Universidad del Valle, Cali, Colombia.
    Salcedo, Alexander
    Trauma and Acute Care Surgery Fellowship, Department of Surgery, Universidad del Valle, Cali, Colombia.
    Peña, Camilo A.
    Trauma and Acute Care Surgery Fellowship, Department of Surgery, Universidad del Valle, Cali, Colombia.
    Angamarca, Edison
    Trauma and Acute Care Surgery Fellowship, Department of Surgery, Universidad del Valle, Cali, Colombia.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Salazar, Camilo J.
    School of Medicine, ICESI University, Cali, Colombia.
    Lopez-Castilla, Valeria
    School of Medicine, ICESI University, Cali, Colombia.
    Ruiz-Yucuma, Juan
    School of Medicine, ICESI University, Cali, Colombia.
    Rodriguez, Fernando
    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.
    Ordoñez, Carlos A.
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Cali, Colombia; Trauma and Acute Care Surgery Fellowship, Department of Surgery, Universidad del Valle, Cali, Colombia.
    A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients.2018In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 85, no 3, p. 626-634Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Serious complications related to groin access have been reported with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA). We performed a systematic review and meta-analysis to estimate the incidence of complications related to groin access from the use of REBOA in adult trauma patients.

    METHODS: We identified articles in MEDLINE and EMBASE. We reviewed all studies that involved adult trauma patients that underwent the placement of a REBOA and included only those that reported the incidence of complications related to groin access. A meta-analysis of proportions was performed RESULTS: We 13 studies with a total of 424 patients. REBOA was inserted most commonly by trauma surgeons or emergency room physicians. Information regarding puncture technique was reported in 12 studies and was available for a total of 414 patients. Percutaneous access and surgical cutdown were performed in 304 (73.4%) and 110 (26.5%) patients respectively. Overall, complications related to groin access occurred in 5.6% of patients (n=24/424). Lower limb amputation was required in 2.1% of patients (9/424), of which three cases (3/424 [0.7%]) were directly related to the vascular puncture from the REBOA insertion. A meta-analysis which used the logit transformation showed a 5% (95% CI 3%-9%) incidence of complications without significant heterogeneity (LR test: χ2 = 0.73, p=0.2, Tau-square=0.2). In a second meta-analysis, we used the Freeman-Turkey double arcsine transformation and found an incidence of complications of 4% (95% CI 2%-7%) with low heterogeneity (I2 = 16.3%).

    CONCLUSION: We found that the incidence of complications related to groin access was of four to five percent based on a meta-analysis of 13 studies published worldwide. Currently, there are no benchmarks or quality measures as a reference to compare, and thus, further work is required to identify these benchmarks and improve the practice of REBOA in trauma surgery.

    LEVEL OF EVIDENCE: Systematic Review and Meta-analysis, Level III.

  • 4.
    Mohseni, Shahin
    et al.
    Örebro University Hospital. Division of Acute Care Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Talving, Peep
    Division of Acute Care Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Wallin, Göran
    Örebro University Hospital. Division of Acute Care Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University Hospital. Division of Acute Care Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Riddez, Louis
    Division of Acute Care Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Preinjury β-blockade is protective in isolated severe traumatic brain injury2014In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 76, no 3, p. 804-808Article in journal (Refereed)
    Abstract [en]

    Background: The purpose of this study was to investigate the effect of preinjury β-blockade in patients experiencing isolated severe traumatic brain injury (TBI). We hypothesized that β-blockade before TBI is associated with improved survival.

    Methods: The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between January 2007 and December 2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS) score of 3 or greater excluding all extracranial injuries AIS score of 3 or greater. Patient demographics, clinical characteristics on admission, injury profile, Injury Severity Score (ISS), AIS score, in-hospital morbidity, and β-blocker exposure were abstracted for analysis. The primary outcome evaluated was in-hospital mortality stratified by preinjury β-blockade exposure.

    Results: Overall, a total of 662 patients met the study criteria. Of these, 25% (n = 159) were exposed to β-blockade before their traumatic insult. When comparing the demographics and injury characteristics between the groups, the sole difference was age, with the β-blocked group being older (69 [12] years vs. 63 [13] years, p < 0.001). β-blocked patients had a higher rate of infectious complications (30% vs. 19%, p = 0.04), with no difference in cardiac or pulmonary complications between the cohorts. Patients exposed to β-blockade versus no β-blockade experienced 13% and 22% mortality, respectively (p = 0.01). Stepwise logistic regression predicted the absence of β-blockade exposure as a risk factor for mortality (odds ratio, 2.7; 95% confidence interval, 1.5-4.8; p = 0.002). After adjustment for significant differences between the groups, patients not exposed to β-blockade experienced twofold increased risk of mortality (adjusted odds ratio, 2.2; 95% confidence interval, 1.3-3.7; p = 0.004).

    Conclusion: Preinjury β-blockade improves survival following isolated severe TBI. The role of prophylactic β-blockade and the timing of initiation of such therapy after TBI warrant further investigations.

    Level of evidence: Therapeutic study, level III; prognostic study, level II.

  • 5.
    Reva, Viktor A.
    et al.
    General and Emergency Surgery, Kirov Academy of Military Medicine, Saint Petersburg, Russia.
    Hörer, Tal M.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Makhnovskiy, Andrey I.
    General and Emergency Surgery, Kirov Academy of Military Medicine, Saint Petersburg, Russia.
    Sokhranov, Mikhail V.
    General and Emergency Surgery, Kirov Academy of Military Medicine, Saint Petersburg, Russia.
    Samokhvalov, Igor M.
    Department of War Surgery, Military Medical Academy, Saint Petersburg, Russia.
    DuBose, Joseph J.
    Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, United States.
    Field and en route resuscitative endovascular occlusion of the aorta: A feasible military reality?2017In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 83, no 1, p. S170-S176Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Severe non-compressible torso hemorrhage (NCTH) remains a leading cause of potentially preventable death in modern military conflicts. Resuscitative endovascular occlusion of the aorta (REBOA) has demonstrated potential as an effective adjunct to the treatment of NCTH in the civilian early hospital and even pre-hospital settings - but the application of this technology for military pre-hospital use has not been well described. We aimed to assess the feasibility of both field and en route pre-hospital REBOA in the military exercise setting simulating a modern armed conflict.

    METHODS: Two adult male Sus Scrofa underwent simulated junctional combat injury in the context of a planned military training exercise. Both underwent zone I REBOA in conjunction with standard tactical combat casualty care (TCCC) interventions - one during point of injury care and the other during en route flight care. Animals were sequentially evacuated to two separate Forward Surgical Teams (FSTs) by rotary wing platform where the balloon position was confirmed by chest X-Ray. Animals then underwent different damage control thoracic and abdominal procedures before euthanasia.

    RESULTS: The first swine underwent immediate successful REBOA at the point of injury 7:30 minutes after the injury. It required 6 minutes total from initiation of procedure to effective aortic occlusion. Total occlusion time was 60 minutes. In the second animal, the REBOA placement procedure was initiated immediately after take-off (17:40 minutes after the injury). Although the movements and vibration of flight were not significant impediments, we only succeeded to put a 6-Fr sheath into a femoral artery during the 14 minutes flight due to lighting and visualization challenges. After the sheath had been upsized in the FST, the REBOA catheter was primarily placed in zone I followed by its replacement to zone III. Both animals survived to study completion and the termination of training. No complications were observed in either animal.

    CONCLUSION: Our study demonstrates the potential feasibility of REBOA for use during tactical field and en route (flight) care of combat casualties. Further study is needed to determine the optimal training and utilization protocols required to facilitate the effective incorporation of REBOA into military pre-hospital care capabilities.

  • 6.
    Wikström, Maria
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery.
    Krantz, Johannes
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Resuscitative endovascular balloon occlusion of the inferior vena cava is made hemodynamically possible by concomitant endovascular balloon occlusion of the aorta: a porcine study2019In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative endovascular balloon occlusion of the vena cava inferior (REBOVC) may provide a minimal invasive alternative for hepatic vascular and inferior vena cava isolation in severe retrohepatic bleeding. However, circulatory stability may be compromised by the obstruction of venous return. The aim was to explore which combinations of arterial and venous endovascular balloon occlusions, and the Pringle maneuver, are hemodynamically possible in a normovolemic pig model. The hypothesis was that lower body venous blood pooling from REBOVC can be avoided by prior resuscitative endovascular aortic balloon occlusion (REBOA).

    METHODS: Nine anesthetized, ventilated, instrumented and normovolemic pigs were used to explore the hemodynamic effects of eleven combinations of REBOA and REBOVC, with or without the Pringle maneuver, in randomized order. The occlusions were performed for 5 minutes but interrupted if systolic blood pressure dropped below 40 mmHg. Hemodynamic variables were measured.

    RESULTS: Proximal REBOVC, isolated or in combination with other methods of occlusion, caused severely decreased systemic blood pressure and cardiac output, and had to be terminated before 5 min. The decreases in systemic blood pressure and cardiac output were avoided by REBOA at the same or a more proximal level. The Pringle maneuver had similar hemodynamic effects to proximal REBOVC.

    CONCLUSIONS: A combination of REBOA and REBOVC provides hemodynamic stability, in contrast to REBOVC alone or with the Pringle maneuver, and may be a possible adjunct in severe retrohepatic venous bleedings.Level of evidenceBasic science study, therapeutic.

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