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  • 1.
    Bilos, Linda
    et al.
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. 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; Örebro University, Örebro, Sweden.
    Vidlund, Mårten
    Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Cha, Soon Ok
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Hörer, Tal
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation2017In: Cardiovascular and Interventional Radiology, ISSN 0174-1551, E-ISSN 1432-086X, Vol. 40, no 1, p. 130-134Article in journal (Refereed)
    Abstract [en]

    Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

  • 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 University, School of Medical Sciences. Örebro University Hospital. 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 exsanguination2018In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 535-550Article, review/survey (Refereed)
    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.
    Brill, Jason B.
    et al.
    Department of Surgery, University of Texas Health Science Center, Houston, Texas.
    Cotton, Bryan A.
    Department of Surgery, University of Texas Health Science Center, Houston, Texas.
    Brenner, Megan
    Department of Surgery, University of California Riverside, Riverside, California, USA.
    Duchesne, Juan
    Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana, USA.
    Ferrada, Paula
    VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Kauvar, David
    Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas, USA.
    Khan, Mansoor
    Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK.
    Roberts, Derek
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada.
    Ordonez, Carlos
    Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Colombia.
    Perreira, Bruno
    Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil.
    Priouzram, Artai
    Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden.
    Kirkpatrick, Andrew
    Regional Trauma Services Foothills Medical Centre; Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Candada; Canadian Forces Health Services, Ottawa, Canada.
    The Role of TEG and ROTEM in Damage Control Resuscitation2021In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 56, no 1S, p. 52-61Article in journal (Refereed)
    Abstract [en]

    ABSTRACT: Trauma induced coagulopathy is associated with very high mortality, and hemorrhage remains the leading preventable cause of death after injury. Directed methods to combat coagulopathy and attain hemostasis are needed. The available literature regarding viscoelastic testing, including thrombelastography (TEG) and rotational thromboelastometry (ROTEM), was reviewed to provide clinically relevant guidance for emergency resuscitation. These tests predict massive transfusion and developing coagulopathy earlier than conventional coagulation testing, within 15 minutes using rapid testing. They can guide resuscitation after trauma, as well. TEG and ROTEM direct early transfusion of fresh frozen plasma when clinical gestalt has not activated a massive transfusion protocol. Reaction time and clotting time via these tests can also detect clinically significant levels of direct oral anticoagulants. Slowed clot kinetics suggest the need for transfusion of fibrinogen via concentrates or cryoprecipitate. Lowered clot strength can be corrected with platelets and fibrinogen. Finally, viscoelastic tests identify fibrinolysis, a finding associated with significantly increased mortality yet one that no conventional coagulation test can reliably detect. Using these parameters, guided resuscitation begins within minutes of a patient's arrival. A growing body of evidence suggests this approach may improve survival while reducing volumes of blood products transfused.

  • 4.
    Buitendag, Johan
    et al.
    Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
    Variawa, Saffiya
    Department of Surgery, Paarl Hospital, Stellenbosch University, Western Cape, South Africa.
    Diayar, Aashish
    Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
    Snyders, Pieter
    Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
    Rademan, Pieter
    Department of Surgery, Worcester Hospital, Stellenbosch University, Western Cape, South Africa.
    Allopi, Nabeel
    Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
    McGreevy, David Thomas
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Oosthuizen, George
    Ngwelezana Surgery and Trauma, Department of Surgery, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa.
    Use of Intermittent Aortic Balloon Occlusion: Report from the ABO Trauma Registry2023In: Journal of Endovascular Resuscitation and Trauma Management, ISSN 2002-7567, Vol. 7, no 1, p. 8-14Article in journal (Refereed)
    Abstract [en]

    Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a helpful adjunct in the management of hemorrhagic shock due to bleeding in the abdomen or pelvis. Ischemia distal to the occlusion is a concern; intermittent aortic balloon inflation (i-REBOA) is a novel way to achieve decreased ischemia time.

    Methods: This study was conducted using data from the multinational ABO Trauma Registry. All patients entered between January 2016 and December 2019 were included.

    Results: The sample consisted of 157 patients. There were 57 patients in the i-REBOA group (36%) and 100 in the REBOA group (64%). The groups were similar in gender (P = 0.50), age (P = 0.17), mechanism of injury (P = 0.42), and injury severity score (P = 0.13). The levels of international normalized ratio (INR) (P < 0.01), activated partial thromboplastin time (aPTT) (P < 0.01) and lactate (P = 0.02) were higher in the i-REBOA group. Total balloon inflation times were longer in the i-REBOA group (P < 0.01). Major complication rates did not differ between groups. Mortality rates between groups were similar in the Emergency Department (ED) (3.8% for i-REBOA vs 10.1%; P = 0.17), within 24 hours (43.4% for i-REBOA vs 38.2%; P = 0.54), and at 30 days (63.6% for i-REBOA vs 48.4%; P = 0.07).

    Conclusions: The data from this registry show that i-REBOA is currently being used and may allow for longer total balloon inflation times without higher morbidity or mortality rates.

  • 5.
    Buitendag, Johan
    et al.
    Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
    Variawa, Saffiya
    Department of Surgery, Paarl Hospital, Stellenbosch University, Western Cape, South Africa.
    Diayar, Aashish
    Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
    Snyders, Pieter
    Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
    Rademan, Pieter
    Department of Surgery, Worcester Hospital, Stellenbosch University, Western Cape, South Africa.
    Allopi, Nabeel
    Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
    McGreevy, David Thomas
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Oosthuizen, George
    Ngwelezana Surgery and Trauma, Department of Surgery, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa.
    ABO Trauma Registry Grp, A. B. O. Trauma Registry
    Comparison of Outcomes Relating to REBOA Inflation Zones: Report from the ABO Trauma Registry2023In: Journal of Endovascular Resuscitation and Trauma Management (JEVTM), ISSN 2002-7567, Vol. 7, no 1, p. 15-21Article in journal (Refereed)
    Abstract [en]

    Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporary management modality for non-compressible torso haemorrhage that can be deployed in the pre- and intrahospital setting. This study aimed to compare outcomes following balloon placement in the three aortic zones.

    Methods: This is a retrospective study using data from the ABO Trauma Registry. Relevant entries from January 2014 to December 2019 were used and stratified into three groups: those who received Zone 1, 2, or 3 balloon placements.

    Results: The study sample consisted of 237 patients: 63 (27%) women and 174 (73%) men, median age 35 years. The primary location of the REBOA balloon was in Zone 1 for 180 patients, while it was nine in Zone 2 and 48 in Zone 3. Complication rates and total durations did not differ significantly between inflation zones. Emergency department mortality rates for Zones 1 and 2 patients were significantly higher than for Zone 3 (P = 0.04), but there was no difference between groups in 24-hour and 30-day mortality rates.

    Conclusions: REBOA is currently used in the emergency setting for temporary stabilisation of the bleeding patient. In this cohort, balloon placement occurred in all zones of the aorta for similar durations, with no difference in complication rates between zones. Inadvertent Zone 2 placement was not found to be associated with increased complication rates.

  • 6.
    Coccolini, Federico
    et al.
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Ceresoli, Marco
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Sadeghi, Mitra
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Skoog, Per
    Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, 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.
    Matsumura, Yosuke
    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, USA.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, Russia; Dzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia.
    Maszkowski, Mariusz
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Fugazzola, Paola
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Tomasoni, Matteo
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Cicuttin, Enrico
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Ansaloni, Luca
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Zaghi, Claudia
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Sibilla, Maria Grazia
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Cremonini, Camilla
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Bersztel, Adam
    Department of Vascular Surgery, Västmanlands Hospital Västerås, Västerås, Sweden; Örebro University, Örebro, Sweden.
    Caragounis, Eva-Corina
    Department of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Falkenberg, Mårten
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Handolin, Lauri
    Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Oosthuizen, George
    Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, University of KwaZulu-Natal College of Health Sciences, KwaZulu-Natal, Pietermaritzburg, South Africa.
    Szarka, Endre
    Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Manchev, Vassil
    Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, University of KwaZulu-Natal College of Health Sciences, KwaZulu-Natal, Pietermaritzburg, South Africa.
    Wannatoop, Tongporn
    Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Chang, Sung Wook
    Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea.
    Kessel, Boris
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Shaked, Gad
    Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel.
    Bala, Miklosh
    Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
    Ordoñez, Carlos A.
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad Del Valle, Cali, Colombia.
    Hibert-Carius, Peter
    Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost Hospital Halle, Halle, Germany.
    Chiarugi, Massimo
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gamberini, Emiliano
    ICU Department Bufalini Hospital, Cesena, Italy.
    Agnoletti, Vanni
    ICU Department Bufalini Hospital, Cesena, Italy.
    Catena, Fausto
    Emergency Surgery Department, Parma University Hospital, Parma, Italy.
    Hörer, Tal M.
    General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy.
    Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry2020In: Updates in surgery, ISSN 2038-3312, Vol. 72, no 2, p. 527-536Article in journal (Refereed)
    Abstract [en]

    EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.

  • 7.
    Coccolini, Federico
    et al.
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Ansaloni, Luca
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Splenic trauma: WSES classification and guidelines for adult and pediatric patients2017In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 12, article id 40Article, review/survey (Refereed)
    Abstract [en]

    Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

  • 8.
    Coccolini, Federico
    et al.
    General Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, , Örebro University Hospital, Örebro, Sweden.
    Catena, Fausto
    Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy.
    The open abdomen in trauma and non-trauma patients: WSES guidelines2018In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 13, article id 7Article, review/survey (Refereed)
    Abstract [en]

    Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.

  • 9.
    Coccolini, Federico
    et al.
    General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery .
    Isik, A
    Liver trauma: WSES 2020 guidelines2020In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 15, no 1, article id 24Article, review/survey (Refereed)
    Abstract [en]

    Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

  • 10.
    Coccolini, Federico
    et al.
    General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Ivatury, Rao
    Virginia Commonwealth Univiversity, Gen & Tauma Surg, Richmond VA, USA.
    Kidney and uro-trauma: WSES-AAST guidelines2019In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 14, no 1, article id 54Article, review/survey (Refereed)
    Abstract [en]

    Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.

  • 11.
    Coccolini, Federico
    et al.
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Stahel, Philip F.
    Department of Orthopedic Surgery, Department of Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver CO, USA.
    Montori, Giulia
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Biffl, Walter
    Acute Care Surgery, The Queen's Medical Center, Honolulu HI, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Dept. of Cardiothoracic and Vascular Surgery & Dept. Of Surgery, Örebro University Hospital, Örebro, Sweden.
    Catena, Fausto
    Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy.
    Kluger, Yoram
    Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel.
    Moore, Ernest E.
    Trauma Surgery, Denver Health, Denver CO, USA.
    Peitzman, Andrew B.
    Surgery Department, University of Pittsburgh, Pittsburgh PA, USA.
    Ivatury, Rao
    Virginia Commonwealth University, Richmond VA, USA.
    Coimbra, Raul
    Department of Surgery, UC San Diego Health System, San Diego, USA.
    Fraga, Gustavo Pereira
    Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas SP, Brazil.
    Pereira, Bruno
    Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas SP, Brazil.
    Rizoli, Sandro
    Trauma & Acute Care Service, St Michael's Hospital, Toronto ON, Canada.
    Kirkpatrick, Andrew
    General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary AB, Canada.
    Leppaniemi, Ari
    Abdominal Center, University Hospital Meilahti, Helsinki, Finland.
    Manfredi, Roberto
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Magnone, Stefano
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Chiara, Osvaldo
    Emergency and Trauma Surgery, Niguarda Hospital, Milan, Italy.
    Solaini, Leonardo
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Ceresoli, Marco
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Allievi, Niccolò
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Arvieux, Catherine
    Digestive and Emergency Surgery, UGA-Université Grenoble Alpes, Grenoble, France.
    Velmahos, George
    Harvard Medical School, Division of Trauma, Emergency Surgery and Surgical Critical Care Massachusetts General Hospital, Boston MA, USA.
    Balogh, Zsolt
    Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle NSW, Australia.
    Naidoo, Noel
    Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
    Weber, Dieter
    Department of General Surgery, Royal Perth Hospital, Perth, Australia.
    Abu-Zidan, Fikri
    Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
    Sartelli, Massimo
    General and Emergency Surgery, Macerata Hospital, Macerata, Italy.
    Ansaloni, Luca
    General and Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Pelvic trauma: WSES classification and guidelines2017In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 12, no 5Article in journal (Refereed)
    Abstract [en]

    Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

  • 12.
    Dogan, Emanuel M.
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Jauring, Oskar
    Department of Anesthesiology and Intensive Care, 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.
    Edström, Måns
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anesthesiology and Intensive Care.
    Intra-aortic and intra-caval balloon pump devices in experimental cardiac arrestManuscript (preprint) (Other academic)
  • 13.
    Dogan, Emanuel M.
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden. emanuel.dogan@regionorebrolan.se.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Jauring, Oskar
    Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, SE-701 85, 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, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Edström, Måns
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anesthesiology and Intensive Care.
    Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation2023In: Journal of Cardiovascular Translational Research, ISSN 1937-5387, E-ISSN 1937-5395, Vol. 16, no 4, p. 948-955Article in journal (Refereed)
    Abstract [en]

    Intra-aortic balloon pump (IABP) use during CPR has been scarcely studied. Intra-caval balloon pump (ICBP) may decrease backward venous flow during CPR. Mechanical chest compressions (MCC) were initiated after 10 min of cardiac arrest in anesthetized pigs. After 5 min of MCC, IABP (n = 6) or ICBP (n = 6) was initiated. The MCC device and the IABP/ICBP had slightly different frequencies, inducing a progressive peak pressure phase shift. IABP inflation 0.15 s before MCC significantly increased mean arterial pressure (MAP) and carotid blood flow (CBF) compared to inflation 0.10 s after MCC and to MCC only. Coronary perfusion pressure significantly increased with IABP inflation 0.25 s before MCC compared to inflation at MCC. ICBP inflation before MCC significantly increased MAP and CBF compared to inflation after MCC but not compared to MCC only. This shows the potential of IABP in CPR when optimally synchronized with MCC. The effect of timing of intra-aortic balloon pump (IABP) inflation during mechanical chest compressions (MCC) on hemodynamics. Data from12 anesthetized pigs.

  • 14.
    Dogan, Emanuel M.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Beskow, Linus
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Calais, Fredrik
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    Resuscitative Endovascular Balloon Occlusion of the Aorta in Experimental Cardiopulmonary Resuscitation: Aortic Occlusion Level Matters2019In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 52, no 1, p. 67-74Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Aortic occlusion during cardiopulmonary resuscitation (CPR) increases systemic arterial pressures. Correct thoracic placement during the resuscitative endovascular balloon occlusion of the aorta (REBOA) may be important for achieving effective CPR.

    HYPOTHESIS: The positioning of the REBOA in the thoracic aorta during CPR will affect systemic arterial pressures.

    METHODS: Cardiac arrest was induced in 27 anesthetized pigs. After 7 min of CPR with a mechanical compression device, REBOA in the thoracic descending aorta at heart level (zone Ib, REBOA-Ib, n = 9), at diaphragmatic level (zone Ic, REBOA-Ic, n = 9) or no occlusion (control, n = 9) was initiated. The primary outcome was systemic arterial pressures during CPR.

    RESULTS: During CPR, REBOA-Ic increased systolic blood pressure from 86 mmHg (confidence interval [CI] 71-101) to 128 mmHg (CI 107-150, P < 0.001). Simultaneously, mean and diastolic blood pressures increased significantly in REBOA-Ic (P < 0.001 and P = 0.006, respectively), and were higher than in REBOA-Ib (P = 0.04 and P = 0.02, respectively) and control (P = 0.005 and P = 0.003, respectively). REBOA-Ib did not significantly affect systemic blood pressures. Arterial pH decreased more in control than in REBOA-Ib and REBOA-Ic after occlusion (P = 0.004 and P = 0.005, respectively). Arterial lactate concentrations were lower in REBOA-Ic compared with control and REBOA-Ib (P = 0.04 and P < 0.001, respectively).

    CONCLUSIONS: Thoracic aortic occlusion in zone Ic during CPR may be more effective in increasing systemic arterial pressures than occlusion in zone Ib. REBOA during CPR was found to be associated with a more favorable acid-base status of circulating blood. If REBOA is used as an adjunct in CPR, it may be of importance to carefully determine the aortic occlusion level.The study was performed following approval of the Regional Animal Ethics Committee in Linköping, Sweden (application ID 418).

  • 15.
    Dogan, Emanuel M.
    et al.
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Edström, Måns
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Martell, Erika A.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sandblom, Isabelle
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Marttala, Jens
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Krantz, Johannes
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Axelsson, Birger
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    Resuscitative endovascular balloon occlusion of the aorta in zone I versus zone III in a porcine model of non-traumatic cardiac arrest and cardiopulmonary resuscitation: A randomized study2020In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 151, p. 150-156Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) in zone I increases systemic blood pressure during cardiopulmonary resuscitation (CPR), while also obstructing the blood flow to distal organs. The aim of the study was to compare the effects on systemic blood pressure and visceral blood flow of REBOA-III (zone III, infrarenal) and REBOA-I (zone I, supraceliac) during non-traumatic cardiac arrest and CPR.

    METHODS: Cardiac arrest was induced in 61 anesthetized pigs. Thirty-two pigs were allocated to a hemodynamic study group where the primary outcomes were systemic arterial pressures and 29 pigs were allocated to a blood flow study group where the primary outcomes were superior mesenteric arterial (SMA) and internal carotid arterial (ICA) blood flow. After 7-8minutes of CPR with a mechanical compression device, REBOA-I, REBOA-III or no aortic occlusion (control group) were initiated after randomization.

    RESULTS: Systemic mean and diastolic arterial pressures were statistically higher during CPR with REBOA-I compared to REBOA-III (50mmHg and 16mmHg in REBOA-I vs 38mmHg and 1mmHg in REBOA-III). Systemic systolic, mean and diastolic arterial pressures were statistically elevated during CPR in the REBOA-I group compared to the controls. The SMA blood flow increased by 49% in REBOA-III but dropped to the levels of the controls within minutes. The ICA blood flow increased the most in REBOA-I compared to REBOA-III and the control group (54%, 19% and 0%, respectively).

    CONCLUSION: In experimental non-traumatic cardiac arrest and CPR, REBOA-I increased systemic blood pressures more than REBOA-III, and the potential enhancement of visceral organ blood flow by REBOA-III was short-lived.

  • 16.
    D'Oria, Mario
    et al.
    Division of Vascular Surgery, Cardiovascular Department, University Hospital of Trieste Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy; Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
    Lembo, Rosalba
    Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Vascular Surgery, Carmel Lady Davis Center, Technion Institute Medical Faculty, Haifa, Israel; Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Rasmussen, Todd
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Mani, Kevin
    Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Parlani, Gianbattista
    Vascular and Endovascular Surgery Unit, S. Maria Misericordia Hospital, University of Perugia, Perugia, Italy.
    Ierardi, Anna Maria
    Diagnostic and Interventional Radiology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
    Veraldi, Gian Franco
    Department of Vascular Surgery, University Hospital and Trust of Verona, Verona, Italy.
    Melloni, Andrea
    Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy.
    Bonardelli, Stefano
    Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy.
    Lepidi, Sandro
    Division of Vascular Surgery, Cardiovascular Department, University Hospital of Trieste Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
    Bertoglio, Luca
    Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy.
    An International Expert-Based CONsensus on Indications and Techniques for aoRtic balloOn occLusion in the Management of Ruptured Abdominal Aortic Aneurysms (CONTROL-RAAA)2023In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, article id 15266028231217233Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To report on the recommendations of an expert-based consensus on the indications, timing, and techniques of aortic balloon occlusion (ABO) in the management of ruptured abdominal aortic aneurysms (rAAA).

    METHODS: Eleven facilitators created appropriate statements regarding the study issues that were voted on using a 4-point Likert scale with open-comment fields, by a selected panel of international experts (vascular surgeons and interventional radiologists) using a 3-round modified Delphi consensus procedure (study period: January-April 2023). Based on the experts' responses, only the statements reaching grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final study report. The consistency of each round's answers was also graded using Cohen's kappa, the intraclass correlation coefficient, and, in case of double resubmission, Fleiss kappa.

    RESULTS: Sixty-three experts were included in the final analysis and voted on 25 statements related to indication and timing (n=6), and techniques (n=19) of ABO in the setting of rAAA. Femoral sheath or ABO should be preferably placed in the operating room, via a percutaneous transfemoral access, on a stiff wire (grade B, consistency I), ABO placement should be suprarenal and last less than 30 minutes (grade B, consistency II), postoperative peripheral vascular status (grade A, consistency II) and laboratory testing every 6 to 12 hours (grade B, consistency) should be assessed to detect complications. Formal training for ABO should be implemented (grade B, consistency I). Most of the statements in this international expert-based Delphi consensus study might guide current choices for indications, timing, and techniques of ABO in the management of rAAA. Clinical practice guidelines should incorporate dedicated statements that can guide clinicians in decision-making.

    CONCLUSIONS: At arrival and during both open or endovascular procedures for rAAA, selective use of intra-aortic balloon occlusion is recommended, and it should be performed preferably by the treating physician in aortic pathology.

    CLINICAL IMPACT: This is the first consensus study of international vascular experts aimed at defining the indications, timing, and techniques of optimal use of ABO in the clinical setting of rAAA. Aortic occlusion by endovascular means (or ABO) is a quick procedure in properly trained hands that may play an important role as a temporizing measure until the definitive aortic repair is achieved, whether by endovascular or open means. Since data on its use in hemodynamically unstable patients are limited in the literature, owing to practical challenges in the performance of well-conducted prospective studies, understanding real-world use by experts is of importance in addressing critical issues and identifying main gaps in knowledge.

  • 17.
    Duchesne, Juan
    et al.
    Tulane University School of Medicine, New Orleans, Louisiana, USA .
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic & Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic & Vascular Surgery.
    DuBose, Joseph
    R. Adams Cowley Shock Trauma, Baltimore Maryland, USA.
    Rasmusse, Todd E.
    Uniformed Services University of the Health Sciences, Bethesda Maryland, USA.
    Brenner, Megan
    Riverside University Health System, Riverside California, USA.
    Jacome, Tomas
    Our Lady of the Lake Regional Medical Center, Baton Rouge Louisiana, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic & Vascular Surgery.
    Tatum, Danielle
    Our Lady of the Lake Regional Medical Center, Baton Rouge Louisiana, USA.
    To Ultrasound or not to Ultrasound: A REBOA Femoral Access Analysis from the ABOTrauma and AORTA Registries2020In: Journal of endovascular resuscitation and trauma management, ISSN 2002-7567, Vol. 4, no 2, p. 80-87Article in journal (Refereed)
    Abstract [en]

    Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct in the management of non-compressible hemorrhage. Ultrasound (US)-guided femoral access has been taught as the best practice for femoral artery cannulation. However, there is a lack of evidence to support its use in patients in extremis with severe hemorrhage. We hypothesize that no differences in outcome will exist between US-guided and to blind percutaneous or cutdown access methods.

    Methods: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. REBOA characteristics and outcomes were compared among puncture access methods. Significance was set at P < 0.05.

    Results: The cohort included 523 patients, primarily male (74%), blunt injured (77%), with median age 40 (27-58), and an Injury Severity Score of 34 (25-45). Percutaneous using external landmarks/palpation was the most common femoral puncture method (53%) used followed by US-guided (27.9%). There was no significant difference in overall complication rates (37.4% vs 34.9%; P = 0.615) or mortality (47.8% vs 50.3%; P = 0.599) between percutaneous and US-guided methods; however, access by cutdown was significantly associated with emergency department (ED) mortality (P = 0.004), 24 hour mortality (P = 0.002), and in-hospital mortality (P = 0.007).

    Conclusions: In patients with severe hemorrhage in need of REBOA placement, the percutaneous approach using anatomic landmarks and palpation, when compared with US-guided femoral access, was used more frequently without an increase in complications, access attempts, or mortality.

  • 18.
    Duchesne, Juan
    et al.
    Riverside University Health System, Riverside, California, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic & Vascular Surgery.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic & Vascular Surgery.
    DuBose, Joseph
    R. Adams Cowley Shock Trauma, Baltimore, Maryland, USA.
    Rasmussen, Todd E.
    Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
    Brenner, Megan
    Riverside University Health System, Riverside, California, USA.
    Jacome, Tomas
    Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic & Vascular Surgery.
    Tatum, Danielle
    Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA.
    Delta Systolic Blood Pressure (SBP) Can be a Stronger Predictor of Mortality Than Pre-Aortic Occlusion SBP in Non-Compressible Torso Hemorrhage: an Abotrauma and AORTA Analysis2021In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 56, no 1S, p. 30-36Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct for the management in patients with severe non-compressible torso hemorrhage (NCTH). Although guidelines have been developed to help with the best indications for REBOA utilization, no studies have addressed the significance of change in systolic blood pressure (ΔSBP) after REBOA insufflation. We hypothesized that ΔSBP would predict mortality in patients with NCTH and have utility as a surrogate marker for hemorrhage status.

    STUDY DESIGN: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. ΔSBP was defined as the difference between pre- and post-REBOA insertion SBP. Based on post-insertion SBP, patient hemorrhage status was categorized as responder or non-responder. A non-responder was defined as a hypotensive patient with systolic blood pressure (SBP) < 90 mmHg after REBOA placement with full aortic occlusion. Significance was set at P < 0.05.

    RESULTS: A total of 524 patients with NCTH were included. Most (74%) were male, 77% blunt injured with a median (IQR) age of 40 (27 - 58) years and ISS 34 (25 - 45). Overall mortality was 51.0%. 20% of patients were classified as non-responders. Demographic and injury descriptors did not differ between groups. Mortality was significantly higher in non-responders vs responders (64% vs 46%, respectively; P = 0.001). Non-responders had lower median pre-insertion SBP (50mmHg vs 67mmHg; P < 0.001) and lower ΔSBP (20mmHg vs 48mmHg; P < 0.001).

    CONCLUSION: REBOA non-responders present and remain persistently hypotensive and are more likely to die than responders, indicating a potential direct correlation between ΔSBP as a surrogate marker of hemorrhage volume status and mortality. Future prospective studies will need to further elucidate the impact of Damage Control Resuscitation efforts on ΔSBP and mortality.

  • 19.
    Duchesne, Juan
    et al.
    Tulane Univiversity, New Orleans LA, USA.
    McGreevy, David
    Örebro University, School of Medical Sciences.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Brenner, Megan
    University of California Riverside, Riverside CA, USA.
    Rasmussen, Todd
    Uniformed Services University, Bethesda MD, USA.
    DuBose, Joseph
    University of Maryland, Baltimore MD, USA.
    Tatum, Danielle
    Our Lady Lake RMC, Baton Rouge LA, USA.
    IMPACT OF INTERMITTENT REBOA USE ON ISCHEMIA REPERFUSION INJURY: A TRANSLATIONAL ANALYSIS2020In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 53, no Suppl. 1, p. 24-24Article in journal (Other academic)
  • 20.
    Duchesne, Juan
    et al.
    Department of Surgery Tulane, New Orleans, Louisiana, USA.
    Taghavi, Sharven
    Department of Surgery Tulane, New Orleans, Louisiana, USA.
    Houghton, August
    Department of Surgery Tulane, New Orleans, Louisiana, USA.
    Khan, Mansoor
    Academic Department of Military Surgery and Trauma, Royal Centre for Defense Medicine, UK.
    Perreira, Bruno
    Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil.
    Cotton, Bryan
    Department of Surgery, University of Texas Health Science Center, Houston, Texas, USA.
    Tatum, Danielle
    Trauma Specialist Program, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA.
    Brenner, Megan
    Department of Surgery, University of California Riverside, Riverside, California, USA.
    Ferrada, Paula
    VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Kauvar, David
    Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas, USA.
    Kirkpatrick, Andrew
    Regional Trauma Services Foothills Medical Centre Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta.
    Ordonez, Carlos
    Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Colombia.
    Priouzram, Artai
    Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden.
    Roberts, Derek
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada.
    Prehospital Mortality Due to Hemorrhagic Shock Remains High and Unchanged: A Summary of Current Civilian EMS Practices and New Military Changes2021In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 56, no 1S, p. 3-8Article in journal (Refereed)
    Abstract [en]

    Mortality secondary to trauma related hemorrhagic shock has not improved for several decades. Underlying the stall in progress is the conundrum of effective pre-hospital interventions for hemorrhage control. As we know, neither pressing hard on the gas nor "Stay and play" have changed mortality over the last 20 years. For this reason, when dealing with effective changes that will improve severe hemorrhage mortality outcomes, there is a need for the creation of a hybrid pre-hospital model.Improvements in mortality outcomes for patients with severe hemorrhage based on evidence for common civilian prehospital procedures such as in-field intubation and immediate fluid resuscitation with crystalloid solution is weak at best. The use of tourniquets, once considered too risky to use, however, has risen dramatically in large part due success seen during their use in the military. Their use in the civilian setting shows promising results. Recently updated military Advanced Resuscitative Care (ARC) guidelines propose the use of prehospital whole blood transfusion as well as in-field use of Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Several case studies from Europe suggest these strategies are feasible for use in the civilian population, but could they be implemented in the U.S.?

  • 21.
    Duchesne, Juan
    et al.
    Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana, USA.
    Taghavi, Sharven
    Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana, USA.
    Khan, Mansoor
    Department of Digestive Diseases, Brighton and Sussex University Hospitals, Brighton, UK.
    Perreira, Bruno
    Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil.
    Cotton, Bryan
    Department of Surgery, University of Texas Health Science Center, Houston, Texas, USA.
    Brenner, Megan
    Department of Surgery, University of California Riverside, Riverside, California, USA.
    Ferrada, Paula
    VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital, Örebro, Sweden.
    Kauvar, David
    Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas, USA.
    Kirkpatrick, Andrew
    Regional Trauma Services Foothills Medical Centre, Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Canadian Forces Health Services, Ottowa, Canada.
    Ordoñez, Carlos
    Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Universidad del Valle, Cali , Colombia.
    Priouzram, Artai
    Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden.
    Roberts, Derek
    Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada.
    Circulatory Trauma: A Paradigm for Understanding the Role of Endovascular Therapy in Hemorrhage Control2021In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 56, no 1S, p. 22-29Article, review/survey (Refereed)
    Abstract [en]

    The pathophysiology of traumatic hemorrhage is a phenomenon of vascular disruption and the symptom of bleeding represents one or more vascular injuries. In the Circulatory Trauma paradigm traumatic hemorrhage is viewed as injury to the circulatory system and suggests the underlying basis for endovascular hemorrhage control techniques. The question "Where is the patient bleeding?" is replaced by "Which blood vessels are disrupted?" and stopping bleeding becomes a matter of selective vessel access and vascular flow control. Control of traumatic hemorrhage has traditionally been performed via external access to the end organ that is bleeding followed by the application of direct pressure, packing, or clamping and repair of directly affected blood vessels. In the circulatory trauma paradigm, bleeding is seen as disruption to vessels which may be accessed internally, from within the vascular system. A variety of endovascular treatments such as balloon occlusion, embolization, or stent grafting can be used to control hemorrhage throughout the body. This narrative review presents a brief overview of the current role of endovascular therapy in the management of circulatory trauma. The authors draw on their personal experience combined with the last decade of published experiences with the use of endovascular techniques in trauma and present general recommendations for their evolving use. The focus of the review is on the use of endovascular techniques as specific vascular treatments using the circulatory trauma paradigm.

  • 22.
    Duchesne, Juan
    et al.
    Tulane Univiversity, New Orleans LA, USA.
    Tatum, Danielle
    Our Lady Lake RMC, Baton Rouge LA, USA.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences.
    McGreevy, David
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    DuBose, Joseph
    R Adams Cowley Shock Trauma, Baltimore MD, USA.
    Brenner, Megan
    University of California, Riverside, Riverside CA, USA.
    IMPACT OF DELTA SYSTOLIC BLOOD PRESSURE AFTER REBOA PLACEMENT IN NON-COMPRESSIBLE TORSO HEMORRHAGE PATIENTS: AN ABOTRAUMA REGISTRY ANALYSIS2019In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 51, no 6, p. 159-159Article in journal (Other academic)
  • 23.
    Engberg, Morten
    et al.
    Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Rasmussen, Todd E.
    Walter Reed National Military Medical Center, Bethesda MD, United States.
    Taudorf, Mikkel
    Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
    Nayahangan, Leizl Joy
    Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.
    Rasmussen, Niklas K.
    Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark.;Copenhagen Univ Hosp, Dept Radiol, Rigshosp, Copenhagen, Denmark.;Copenhagen Univ Hosp, Dept Intens Care, Rigshosp, Copenhagen, Denmark..
    Russell, Lene
    Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.
    Konge, Lars
    Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Lönn, Lars
    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Developing a tool to assess competence in resuscitative endovascular balloon occlusion of the aorta: An international Delphi consensus study2021In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 91, no 2, p. 310-317Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure that is potentially lifesaving in major noncompressible torso hemorrhage. It may also improve outcome in nontraumatic cardiac arrest. However, the procedure can be technically challenging and requires the immediate presence of a qualified operator. Thus, evidence-based training and assessment of operator skills are essential for successful implementation and patient safety. A prerequisite for this is a valid and reliable assessment tool specific for the procedure. The aim of this study was to develop a tool for assessing procedural competence in REBOA based on best-available knowledge from international experts in the field.

    METHODS: We invited international REBOA experts from multiple specialties to participate in an anonymous three-round iterative Delphi study to reach consensus on the design and content of an assessment tool. In round 1, participants suggested items to be included. In rounds 2 and 3, the relevance of each suggested item was evaluated by all participants to reach consensus. Interround data processing was done systematically by a steering group.

    RESULTS: Forty panelists representing both clinical and educational expertise in REBOA from 16 countries (in Europe, Asia, and North and South America) and seven different specialties participated in the study. After 3 Delphi rounds and 532 initial item suggestions, the panelists reached consensus on a 10-item assessment tool with behaviorally anchored rating scales. It includes assessment of teamwork, procedure time, selection and preparation of equipment, puncture technique, guidewire handling, sheath handling, placement of REBOA catheter, occlusion, and evaluation.

    CONCLUSION: We present the REBOA-RATE assessment tool developed systematically by international experts in the field to optimize content validity. Following further studies of its validity and reliability, this tool represents an important next step in evidence-based training programs in REBOA, for example, using mastery learning.

  • 24.
    Engberg, Morten
    et al.
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Lönn, Lars
    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
    Konge, Lars
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Mikkelsen, Søren
    The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care, Region of Southern Denmark, Odense University Hospital, Odense, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery and Department of Surgery, Faculty of Life Science.
    Lindgren, Hans
    Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Section of Interventional Radiology, Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
    Søvik, Edmund
    Department of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway.
    Svendsen, Morten Bo
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen, Denmark.
    Frendø, Martin
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen, Denmark; Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
    Taudorf, Mikkel
    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
    Russell, Lene
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, Capital Region of Denmark, Copenhagen, Denmark; Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
    Reliable and valid assessment of procedural skills in resuscitative endovascular balloon occlusion of the aorta2021In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 91, no 4, p. 663-671Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Valid and reliable assessment of skills is essential for improved and evidence-based training concepts. In a recent study, we presented a novel tool to assess procedural skills in resuscitative endovascular balloon occlusion of the aorta (REBOA), REBOA-RATE, based on international expert consensus. Although expert consensus is a strong foundation, the performance of REBOA-RATE has not been explored. The study aimed to examine the reliability and validity of REBOA-RATE.

    METHODS: This was an experimental simulation-based study. We enrolled doctors with three levels of expertise to perform two REBOA procedures in a simulated scenario of out-of-hospital cardiac arrest. Procedures were video-recorded, and videos were blinded and randomized. Three clinical experts independently rated all procedures using REBOA-RATE. Data were analyzed using Messick's framework for validity evidence, including generalizability analysis of reliability and determination of a pass/fail standard.

    RESULTS: Forty-two doctors were enrolled: 16 novices, 13 anesthesiologists, and 13 endovascular experts. They all performed two procedures, yielding 84 procedures and 252 ratings. The REBOA-RATE assessment tool showed high internal consistency (Cronbach's alpha = 0.95) and excellent interrater reliability (intraclass correlation coefficient, 0.97). Assessment using one rater and three procedures could ensure overall reliability suitable for high-stakes testing (G-coefficient >0.80). Mean scores (SD) for the three groups in the second procedure were as follows: novices, 32% (24%); anesthesiologists, 55% (29%); endovascular experts, 93% (4%) (p < 0.001). The pass/fail standard was set at 81%, which all experts but no novices passed.

    CONCLUSION: Data strongly support the reliability and validity of REBOA-RATE, which successfully discriminated between all experience levels. The REBOA-RATE assessment tool requires minimal instruction, and one rater is sufficient for reliable assessment. Together, these are strong arguments for the use of REBOA-RATE to assess REBOA skills, allowing for competency-based training and certification concepts.

  • 25.
    Engberg, Morten
    et al.
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, the Capital Region of Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Mikkelsen, Soren
    The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark; The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery and Department of Surgery, Faculty of Life Science.
    Lindgren, Hans
    Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of Surgery, Section of Interventional Radiology, Helsingborg Hospital, Helsingborg, Sweden.
    Søvik, Edmund
    Department of Radiology and Nuclear Medicine, St. Olavs University Hospital, Trondheim, Norway.
    Frendø, Martin
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, the Capital Region of Denmark; Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital Herlev, Denmark.
    Svendsen, Morten Bo
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, the Capital Region of Denmark.
    Lönn, Lars
    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Copenhagen University Hospital Rigshospitalet, Denmark.
    Konge, Lars
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, the Capital Region of Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Russell, Lene
    Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, the Capital Region of Denmark; Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital Gentofte, Denmark.
    Taudorf, Mikkel
    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Copenhagen University Hospital Rigshospitalet, Denmark.
    Learning insertion of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter: Is clinical experience necessary? A prospective trial2023In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 54, no 5, p. 1321-1329Article in journal (Refereed)
    Abstract [en]

    Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging and po-tentially life-saving procedure, necessitating qualified operators in an increasing number of centres. The procedure shares technical elements with other vascular access procedures using the Seldinger technique, which is mastered by doctors not only in endovascular specialties but also in trauma surgery, emergency medicine, and anaesthesiology. We hypothesised that doctors mastering the Seldinger technique (expe-rienced anaesthesiologist) would learn the technical aspects of REBOA with limited training and remain technically superior to doctors unfamiliar with the Seldinger technique (novice residents) given similar training.

    Methods: This was a prospective trial of an educational intervention. Three groups of doctors were en-roled: novice residents, experienced anaesthesiologists, and endovascular experts. The novices and the anaesthesiologists completed 2.5 h of simulation-based REBOA training. Their skills were tested before and 8-12 weeks after training using a standardised simulated scenario. The endovascular experts, con-stituting a reference group, were equivalently tested. All performances were video recorded and rated by three blinded experts using a validated assessment tool for REBOA (REBOA-RATE). Performances were compared between groups and with a previously published pass/fail cutoff.

    Results: Sixteen novices, 13 board-certified specialists in anaesthesiology, and 13 endovascular experts participated. Before training, the anaesthesiologists outperformed the novices by 30 percentage points of the maximum REBOA-RATE score (56% (SD 14.0) vs 26% (SD 17%), p < 0.01). After training, there was no difference in skills between the two groups (78% (SD 11%) vs 78 (SD 14%), p = 0.93). Neither group reached the endovascular experts' skill level (89% (SD 7%), p < 0.05).

    Conclusion: For doctors mastering the Seldinger technique, there was an initial inter-procedural transfer of skills advantage when performing REBOA. However, after identical simulation-based training, novices performed equally well to anaesthesiologists, indicating that vascular access experience is not a prerequi-site to learning the technical aspects of REBOA. Both groups would need more training to reach technical proficiency.

  • 26. Fujita, Satoko
    et al.
    Hörer, Tal
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences.
    Toivola, Asko
    Gruber, Göran
    Larzon, Thomas
    Onyx Embolization as Single Rescue Treatment for Ruptured Abdominal Aortic After EVAR2016In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 11, no 5, p. 370-372Article in journal (Refereed)
    Abstract [en]

    A 76-year-old man who had undergone endovascular repair for an infrarenal aortic aneurysm, presented with a late type Ia endoleak 3 years after his operation. Deployment of an aortic cuff did not achieve a better seal at the proximal neck, and the aneurysm developed a rupture. We successfully treated the ruptured aneurysm using transcatheter Onyx embolization only. At 6-month and 1-year follow-ups with contrast-enhanced duplex scanning, no endoleak was seen and sac shrinkage was observed. Onyx is a relatively new liquid embolic agent that is slowly transformed into a solid state by contact with blood. Owing to this unique characteristic, Onyx embolization can be a useful technique for stopping bleeding from an aneurysm in an emergency situation. This is a unique case of the use of an embolization agent in the treatment of aortic aneurysm rupture.

  • 27.
    Gamberini, Emiliano
    et al.
    Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center Maurizio Bufalini Hospital, Cesena, Italy.
    Coccolini, Federico
    General and Emergency Surgery Department, ASST Trauma Center Papa Giovanni XXIII Hospital, Bergamo, Italy.
    Tamagnini, Beatrice
    Emergency Medicine, University of Modena and Reggio Emilia, Modena, Italy.
    Martino, Costanza
    Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center Maurizio Bufalini Hospital, Cesena, Italy.
    Albarello, Vittorio
    Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center Maurizio Bufalini Hospital, Cesena, Italy.
    Benni, Marco
    Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center Maurizio Bufalini Hospital, Cesena, Italy.
    Bisulli, Marcello
    Interventional Radiology Department, AUSL Romagna Trauma Center Maurizio Bufalini Hospital, Cesena, Italy.
    Fabbri, Nicola
    AUSL Romagna Trauma Center Maurizio Bufalini Hospital, General and Emergency Surgery Department, Cesena, Italy.
    Hörer, Tal Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Cardiothoracic and Vascular Surgery Department, Örebro University Hospital, Örebro, Sweden.
    Ansaloni, Luca
    General and Emergency Surgery Department, AUSL Romagna Trauma Center Maurizio Bufalini Hospital, Cesena, Italy.
    Coniglio, Carlo
    Anesthesia, Intensive Care and 118 Emergency System Department, AUSL Bologna Trauma Center Maggiore Hospital, Bologna, Italy.
    Barozzi, Marco
    Emergency Medicine Department, AUSL Modena Trauma Center Sant'Agostino Hospital, Modena, Italy.
    Agnoletti, Vanni
    Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center Maurizio Bufalini Hospital, Cesena, Italy.
    Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature2017In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 12, article id 42Article, review/survey (Refereed)
    Abstract [en]

    Aims: Resuscitative endovascular balloon occlusion of the aorta has been a hot topic in trauma resuscitation during these last years. The aims of this systematic review are to analyze when, how, and where this technique is performed and to evaluate preliminary results.

    Methods: The literature search was performed on online databases in December 2016, without time limits. Studies citing endovascular balloon occlusion of the aorta in trauma were retrieved for evaluation.

    Results: Sixty-one articles met the inclusion criteria and were selected for the systematic review. Overall, they included 1355 treated with aortic endovascular balloon occlusion, and 883 (65%) patients died after the procedure. In most of the included cases, a shock state seemed to be present before the procedure. Time of death and inflation site was not described in the majority of included studies. Procedure-related and shock-related complications are described. Introducer sheath size and comorbidity seems to play the role of risk factors.

    Conclusions: Resuscitative endovascular balloon occlusion of the aorta is increasingly used in trauma victim resuscitation all over the world, to elevate blood pressure and limit fluid infusion, while other procedures aimed to stop the bleeding are performed. High mortality rate is probably due to the severity of the injuries. Time and place of balloon insertion, zone of balloon inflation, and inflation cutoff time are very heterogeneous.

  • 28.
    Gavali, Hamid
    et al.
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Mani, Kevin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Furebring, Mia
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
    Olsson, Karl W.
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Lindström, David
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Sörelius, Karl
    Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Sigvant, Birgitta
    Örebro University, School of Medical Sciences. Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Gidlund, Khatereh D.
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Gävle County Hospital, Gävle, Sweden .
    Torstensson, Gustav
    Department of Vascular Surgery, Helsingborg Regional Hospital, Helsingborg, Sweden.
    Andersson, Manne
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; County Hospital Ryhov, Jönköping County, Department of Surgery, Ryhov, Sweden.
    Forssell, Claes
    Department of Cardiovascular Surgery, Division of Vascular Surgery, Linköping University Hospital, Linköping, Sweden.
    Åstrand, Håkan
    Department of Surgery, County Hospital Ryhov, Jönköping County, Jönköping, Sweden.
    Lundström, Tobias
    Department of Surgery and urology, Eskilstuna Hospital, Eskilstuna, Sweden.
    Khan, Shahzad
    Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden.
    Sonesson, Björn
    Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden.
    Stackelberg, Otto
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Gillgren, Peter
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
    Isaksson, Jon
    Department of Surgical and Peri-operative Sciences, Umeå University, Umeå, Sweden.
    Kragsterman, Björn
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Västerås Central Hospital, Västerås, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery and Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sadeghi, Mitra
    Department of Cardiothoracic and Vascular Surgery and Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Wanhainen, Anders
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study2021In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 62, no 6, p. 918-926Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study.

    METHODS: The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 and May 2017. The primary aim was to compare short and long term survival, as well as complications for EAB and ISR.

    RESULTS: Some 126 radically surgically treated AGI patients were identified - 102 graft infections and 24 endograft infections - treated by EAB: 71 and ISR: 55 (23 neo-aorto-iliac systems, NAISs). No differences in early 30 day (EAB 81.7% vs. ISR 76.4%, p = .46), or long term five year survival (48.2% vs. 49.9%, p = .87) were identified. There was no survival difference comparing NAIS to other ISR strategies. The frequency of recurrent graft infection during follow up was similar: EAB 20.3% vs. ISR 17.0% (p = .56). Survival and re-infection rates of the new conduit did not differ between NAIS and other ISR strategies. Age ≥ 75 years (odds ratio [OR] 4.0, confidence interval [CI] 1.1 - 14.8), coronary artery disease (OR 4.2, CI 1.2 - 15.1) and post-operative circulatory complications (OR 5.2, CI 1.2 - 22.5) were associated with early death. Prolonged antimicrobial therapy (> 3 months) was associated with reduced long term mortality (HR 0.3, CI 0.1 - 0.9).

    CONCLUSION: In this nationwide multicentre study comparing outcomes of radically treated AGI, no differences in survival or re-infection rate could be identified comparing EAB and ISR.

  • 29.
    Gavali, Hamid
    et al.
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Mani, Kevin
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Furebring, Mia
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
    Olsson, Karl Wilhelm
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Lindstrom, David
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Sorelius, Karl
    Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Sigvant, Birgitta
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Vascular Surgery, Karlstad Central Hospital, Karlstad, Sweden.
    Torstensson, Gustav
    Department of Surgery, Helsingborg Regional Hospital, Helsingborg, Sweden.
    Andersson, Manne
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden.
    Forssell, Claes
    Department of Cardiovascular Surgery, Division of Vascular Surgery, Linköping University Hospital, Linköping, Sweden.
    Astrand, Håkan
    Department of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden.
    Lundstrom, Tobias
    Department of Surgery and Urology, Eskilstuna Hospital, Eskilstuna, Sweden.
    Khan, Shahzad
    Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden.
    Sonesson, Bjorn
    Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden.
    Stackelberg, Otto
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Gillgren, Peter
    Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Södersjukhuset, Stockholm, Sweden.
    Isaksson, Jon
    Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
    Kragsterman, Björn
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Västerås Central Hospital, Västerås, Sweden.
    Gidlund, Khatereh Djavani
    Department of Cardiothoracic and Vascular Surgery and Department of Surgery.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery and Department of Surgery.
    Sadeghi, Mitra
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
    Wanhainen, Anders
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
    Semi-Conservative Treatment Versus Surgery in Abdominal Aortic Graft and Endograft Infections2023In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 66, no 3, p. 397-406Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Abdominal aortic graft and endograft infections (AGIs) are rare complications following aortic surgery. Radical surgery (RS) with resection of the infected graft and reconstruction with extra-anatomical bypass or in situ reconstruction is the preferred therapy. For patients unfit for RS, a semi-conservative (SC), graft-preserving strategy is possible. This paper aimed to compare survival and infection outcomes between RS and SC treatment for AGI in a nationwide cohort.

    METHODS: Patients with abdominal AGI-related surgery in Sweden between January 1995 and May 2017 were identified. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used for definition of AGI. Multivariable regression was performed to identify factors associated with mortality.

    RESULTS: A total of 169 patients with surgically treated abdominal AGI were identified, comprising 43 SC [14 endografts; 53% with a graft-enteric fistula (GEF) in total] and 126 RS [26 endografts; 50% with a GEF in total]. The SC cohort was older and had a higher frequency of cardiac comorbidities. There was a non-significant trend towards lower Kaplan-Meier estimated 5-year survival for SC versus RS (30.2% vs. 48.4%; p = .066). A non-significant trend was identified towards worse Kaplan-Meier estimated 5-year survival for SC patients with a GEF versus without a GEF (21.7% vs. 40.1%; p = .097). There were significantly more recurrent graft infections comparing SC versus RS (45.4% vs. 19.3%; p < .001). In a Cox regression model adjusting for confounders, there was no difference in 5-year survival comparing SC versus RS (HR 1.0, 95% CI 0.6 - 1.5).

    CONCLUSION: In this national AGI cohort, we could not identify any mortality difference comparing SC versus RS for AGI when adjusting for comorbidities. Presence of GEF likely negatively impacts survival outcomes of SC patients. Rates of recurrent infection remain high for SC-treated patients.

  • 30.
    Hatchimonji, Justin S.
    et al.
    Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
    Chipman, Amanda M.
    R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland Medical Center, Baltimore, Maryland, USA.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Burruss, Sigrid
    Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
    Han, Stephanie
    Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
    Spalding, M. Chance
    Department of Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, USA.
    Fox, Charles J.
    Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA.
    Moore, Ernest E.
    Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA.
    Diaz, Jose J.
    R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland Medical Center, Baltimore, Maryland, USA.
    Cannon, Jeremy W.
    Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
    Resuscitative Endovascular Balloon Occlusion of Aaorta Use in Nontrauma Emergency General Surgery: A Multi-institutional Experience2020In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 256, p. 149-155Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to determine the current utilization patterns of resuscitative endovascular balloon occlusion of aorta (REBOA) for hemorrhage control in nontrauma patients.

    METHODS: Data on REBOA use in nontrauma emergency general surgery patients from six centers, 2014-2019, was pooled for analysis. We performed descriptive analyses using Fisher's exact, Student's t, chi-squared, or Mann-Whitney U tests as appropriate.

    RESULTS: Thirty-seven patients with acute hemorrhage from nontrauma sources were identified. REBOA placement was primarily performed by trauma attendings (20/37, 54%) and vascular attendings (13/37, 35%). In seven patients (19%), balloons were positioned prophylactically but never inflated. In 24 (65%) of 37 patients, REBOA was placed in the operating room. 28/37 balloons (76%) were advanced to zone 1, 8/37 (22%) were advanced to zone 3, and there was one REBOA use in the inferior vena cava. Most common indications were gastrointestinal and peripartum bleeding. In the 30 cases of balloon inflation, 24 of 30 (80%) resulted in improved hemodynamics. Eleven of 30 patients (37%) died before discharge. One patient developed a distal embolism, but there were no reports of limb loss. Twelve patients (40% of all REBOA inflations and 63% of survivors) were discharged to home.

    CONCLUSIONS: REBOA has been used in a range of acutely hemorrhaging emergency general surgery patients with low rates of access-related complications. Mortality is high in this patient population and further research is needed; however, appropriate patient selection and early use may improve survival in these life-threatening cases.

  • 31.
    Hibert-Carius, Peter
    et al.
    Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost Hospital Halle, Halle, Germany.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Abu-Zidan, Fikri M.
    Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Revised Injury Severity Classification II (RISC II) is a predictor of mortality in REBOA-managed severe trauma patients2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 2, article id e0246127Article in journal (Refereed)
    Abstract [en]

    The evidence supporting the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in severely injured patients is still debatable. Using the ABOTrauma Registry, we aimed to define factors affecting mortality in trauma REBOA patients. Data from the ABOTrauma Registry collected between 2014 and 2020 from 22 centers in 13 countries globally were analysed. Of 189 patients, 93 died (49%) and 96 survived (51%). The demographic, clinical, REBOA criteria, and laboratory variables of these two groups were compared using non-parametric methods. Significant factors were then entered into a backward logistic regression model. The univariate analysis showed numerous significant factors that predicted death including mechanism of injury, ongoing cardiopulmonary resuscitation, GCS, dilated pupils, systolic blood pressure, SPO2, ISS, serum lactate level and Revised Injury Severity Classification (RISCII). RISCII was the only significant factor in the backward logistic regression model (p < 0.0001). The odds of survival increased by 4% for each increase of 1% in the RISCII. The best RISCII that predicted 30-day survival in the REBOA treated patients was 53.7%, having a sensitivity of 82.3%, specificity of 64.5%, positive predictive value of 70.5%, negative predictive value of 77.9%, and usefulness index of 0.385. Although there are multiple significant factors shown in the univariate analysis, the only factor that predicted 30-day mortality in REBOA trauma patients in a logistic regression model was RISCII. Our results clearly demonstrate that single variables may not do well in predicting mortality in severe trauma patients and that a complex score such as the RISC II is needed. Although a complex score may be useful for benchmarking, its clinical utility can be hindered by its complexity.

  • 32.
    Hilbert-Carius, Peter
    et al.
    Department of Anesthesiology, Emergency and Intensive Care Medicine, Halle, Germany.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Abu-Zidan, Fikri M.
    Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Pre-hospital CPR and early REBOA in trauma patients: esults from the ABOTrauma Registry2020In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 15, no 1, article id 23Article in journal (Refereed)
    Abstract [en]

    Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR.

    Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate.

    Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to the hospital with ongoing CPR. Nine patients (35%) died within the first 24 h, while seventeen patients (65%) survived post 24 h. The survival rate to hospital discharge was 27% (n = 7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p = 0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. The survival rate in the 16 patients responding to REBOA was 37.5% (n = 6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from the median (range) 56.5 (0-147) to 90 (0-200) mmHg.

    Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated.

  • 33.
    Hilbert-Carius, Peter
    et al.
    Department of Anesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital Halle, Halle (Saale), Germany.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Abu-Zidan, Fikri M.
    Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry2020In: World Journal of Emergency Surgery, ISSN 1749-7922, E-ISSN 1749-7922, Vol. 15, no 1, article id 62Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about "Who is and who should be performing it?"

    METHODS: Data from the international ABO (aortic balloon occlusion) Trauma Registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how, and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients.

    RESULTS: During the study period, 259 patients had been recorded in the registry, 72.5% (n = 188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5%, and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common femoral artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cutdown in 57 patients (24%), using ultrasound in 49 patients (21%), and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient's age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room, and mortality.

    CONCLUSION: A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cutdown is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing "Who should be performing REBOA?" future research should focus on "Which patient benefits most from REBOA?"

  • 34.
    Hurtsén, Anna Stene
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Centre for Clinical Research and Education, County Council of Värmland, Karlstad, Sweden.
    McGreevy, David T.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Karlsson, Christina
    Örebro University, School of Health Sciences.
    Frostell, Claes G.
    Anesthesiology and Intensive Care, Department of Clinical Sciences, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury2023In: Intensive Care Medicine Experimental, E-ISSN 2197-425X, Vol. 11, no 1, article id 18Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The definition of partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is not yet determined and clinical markers of the degree of occlusion, metabolic effects and end-organ injury that are clinically monitored in real time are lacking. The aim of the study was to test the hypothesis that end-tidal carbon dioxide (ETCO2) targeted pREBOA causes less metabolic disturbance compared to proximal systolic blood pressure (SBP) targeted pREBOA in a porcine model of hemorrhagic shock.

    MATERIALS AND METHODS: Twenty anesthetized pigs (26-35 kg) were randomized to 45 min of either ETCO2 targeted pREBOA (pREBOAETCO2, ETCO2 90-110% of values before start of occlusion, n = 10) or proximal SBP targeted pREBOA (pREBOASBP, SBP 80-100 mmHg, n = 10), during controlled grade IV hemorrhagic shock. Autotransfusion and reperfusion over 3 h followed. Hemodynamic and respiratory parameters, blood samples and jejunal specimens were analyzed.

    RESULTS: ETCO2 was significantly higher in the pREBOAETCO2 group during the occlusion compared to the pREBOASBP group, whereas SBP, femoral arterial mean pressure and abdominal aortic blood flow were similar. During reperfusion, arterial and mesenteric lactate, plasma creatinine and plasma troponin concentrations were higher in the pREBOASBP group.

    CONCLUSIONS: In a porcine model of hemorrhagic shock, ETCO2 targeted pREBOA caused less metabolic disturbance and end-organ damage compared to proximal SBP targeted pREBOA, with no disadvantageous hemodynamic impact. End-tidal CO2 should be investigated in clinical studies as a complementary clinical tool for mitigating ischemic-reperfusion injury when using pREBOA.

  • 35.
    Hörer, Tal
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Early detection of major surgical postoperative complications evaluated by microdialysis2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Major abdominal surgery may be followed by postoperative complications, especially in the elderly and patients with co morbidities as diabetes mellitus and obesity. Some of the most feared complications as anastomotic leakage, abdominal infections, abdominal compartment syndrome (ACS) and intestinal ischemia can lead to sepsis, systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) with high morbidity and mortality. This thesis evaluates intraperitoneal microdialysis (IPM) as a method for early detection of surgical complications. IPM measures extracellular metabolites as lactate, pyruvate, glycerol and glucose. The lactate/pyruvate (l/p) ratio describes the current relationship between aerobic and anaerobic metabolism. Glycerol is a degradation product of lipolysis from fat and a part of the cell membrane and released when cell injury occurs. In Paper I, evaluation of IPM in patients with and without diabetes mellitus and obesity during 48 hours after abdominal surgery did not show any difference in l/p ratio and glycerol levels compared to a control group. Paper II investigated the first two days after abdominal surgery in patients with major complications using IPM. L/p ratio was higher and glycerol was lower. Paper III used IPM in the immediate postoperative period in patients after endovascular repair for ruptured abdominal aortic aneurysm (rEVAR). Patients who required decompression due to intraabdominal hypertension (IAH) with organ failure had higher l/p ratio and glycerol. Paper IV investigated the effects of Aortic Balloon Occlusion (ABO) and Superior Mesenteric Artery (SMA) occlusion for one hour followed by three hours reperfusion in an animal model. ABO had a pronounced effect on the hemodynamic state. I.p l/p ratio increased during ischemia and decreased on reperfusion while glycerol increased on reperfusion and the effect was less pronounced in the SMA group. In conclusion, IPM monitoring of l/p ratio and glycerol indicates serious postoperative complications at an early stage. The l/p ratio increases or is continuously high while glycerol seems to have a more complex pattern. Diabetes and obesity do not influence the results.

    List of papers
    1. Complications but not obesity or diabetes mellitus have impact on the intraperitoneal lactate/pyruvate ratio measured by microdialysis
    Open this publication in new window or tab >>Complications but not obesity or diabetes mellitus have impact on the intraperitoneal lactate/pyruvate ratio measured by microdialysis
    2010 (English)In: Scandinavian Journal of Gastroenterology, ISSN 1502-7708, Vol. 45, no 1, p. 115-121Article in journal (Refereed) Published
    Abstract [en]

    Objective: Studies have shown a higher risk of postoperative complications in diabetic and obese patients. An increased intraperitoneal lactate/pyruvate ratio as measured by microdialysis has been reported before postoperative complications have been discovered. It is not known whether diabetes or obesity have any influence on the intraperitoneal metabolism (lactate/pyruvate ratio, glucose, glycerol) in relation to major abdominal surgery. The aim of this study was to investigate the postoperative intraperitoneal and subcutaneous carbohydrate and fat metabolism as measured by microdialysis in obese and diabetic patients after major abdominal surgery without postoperative complications.

    Material and methods: Seven obese patients (body mass index > 30 kg/m(2)) and six diabetic but non-obese patients were studied up to 48 h after major abdominal surgery and were compared with 31 non-diabetic, non-obese patients, all without complications. Microdialysis was performed to measure glucose, lactate, pyruvate and glycerol intraperitoneally and subcutaneously. The lactate/pyruvate ratio was calculated.

    Results: The lactate/pyruvate ratio did not differ between the groups. In the diabetic patients, glucose levels were higher intraperitoneally at both Days 1 and 2 compared to controls. Higher glycerol levels were found subcutaneously in obese patients at Day 2. CONCLUSIONS: The lactate/pyruvate ratio does not increase intraperitoneally after non-complicated major abdominal surgery in diabetic and obese patients. Obese patients have increased release of free fatty acids and glycerol subcutaneously, while diabetic patients show higher glucose levels intraperitoneally than controls.

    Keywords
    Diabetes, glucose, glycerol, intraperitoneal microdialysis, lactate/pyruvate ratio, obesity
    National Category
    Gastroenterology and Hepatology Medical and Health Sciences Surgery
    Research subject
    Medicine; Surgery
    Identifiers
    urn:nbn:se:oru:diva-11986 (URN)10.3109/00365520903386713 (DOI)000274344000016 ()19961346 (PubMedID)2-s2.0-73649132923 (Scopus ID)
    Available from: 2010-10-04 Created: 2010-10-04 Last updated: 2023-12-08Bibliographically approved
    2. Intraperitoneal glycerol levels and lactate/pyruvate ratio: early markers of postoperative complications
    Open this publication in new window or tab >>Intraperitoneal glycerol levels and lactate/pyruvate ratio: early markers of postoperative complications
    2011 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 46, no 7-8, p. 913-919Article in journal (Refereed) Published
    Abstract [en]

    Objective: We have previously presented microdialysis findings of early intraperitoneal (ip) metabolic disturbances, mainly an increased lactate/pyruvate (l/p) ratio, in surgical patients developing postoperative complications. The aim of the present study was to investigate ip glycerol and l/p ratio after major surgery with and without complications.

    Material and methods :Sixty patients were followed with microdialysis for 48 h after major abdominal surgery, 44 patients without postoperative complications and 16 patients with major surgical complications. Intraperitoneal and subcutaneous (sc) measurements of glycerol, lactate, pyruvate and glucose were performed, and the l/p ratio was calculated.

    Results: Intraperitoneal glycerol was significantly lower in the complication group compared with the control group (64 vs. 94.6 μM; p = 0.0015), while the ip l/p ratio was significantly higher in the complication group compared with the control group (13.7 vs. 11.1; p = 0.0073).

    Conclusions: In this study, ip glycerol levels were lower and ip l/p ratio was higher in the immediate postoperative period in a group of patients with complications. These results might indicate early ip disturbances in fat and carbohydrate metabolism in patients who later developed symptoms of postoperative major complications.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2011
    Keywords
    Glucose, glycerol, intraperitoneal, lactate, lactate/pyruvate ratio, microdialysis, postoperative complications
    National Category
    Gastroenterology and Hepatology
    Identifiers
    urn:nbn:se:oru:diva-15172 (URN)10.3109/00365521.2011.568519 (DOI)000292646800021 ()21443418 (PubMedID)2-s2.0-79960245414 (Scopus ID)
    Projects
    Intraabdominal metabolism/microdialysis
    Available from: 2011-04-04 Created: 2011-04-01 Last updated: 2021-08-19Bibliographically approved
    3. Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms
    Open this publication in new window or tab >>Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms
    Show others...
    2013 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 45, no 6, p. 596-606Article in journal (Refereed) Published
    Abstract [en]

    Objectives: This study aims to evaluate intra-peritoneal (ip) microdialysis after endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) in patients developing intra-abdominal hypertension (IAH), requiring abdominal decompression.

    Design: Prospective study.

    Material and methods: A total of 16 patients with rAAA treated with an emergency EVAR were followed up hourly for intra-abdominal pressure (IAP), urine production and ip lactate, pyruvate, glycerol and glucose by microdialysis, analysed only at the end of the study. Abdominal decompression was performed on clinical criteria, and decompressed (D) and non-decompressed (ND) patients were compared.

    Results: The ip lactate/pyruvate (l/p) ratio was higher in the D group than in the ND group during the first five postoperative hours (mean 20 vs. 12), p = 0.005 and at 1 h prior to decompression compared to the fifth hour in the ND group (24 vs. 13), p = 0.016. Glycerol levels were higher in the D group during the first postoperative hours (mean 274.6 vs. 121.7 mu M), p = 0.022. The IAP was higher only at 1 h prior to decompression in the D group compared to the ND group at the fifth hour (mean 19 vs. 14 mmHg).

    Conclusions: lp l/p ratio and glycerol levels are elevated immediately postoperatively in patients developing IAH leading to organ failure and subsequent abdominal decompression.

    Keywords
    Ruptured aortic aneurysm, Intra-abdominal hypertension, Metabolism, Microdialysis, Lactate, Pyruvate, Glycerol
    National Category
    Surgery
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-30189 (URN)10.1016/j.ejvs.2013.03.002 (DOI)000320745100012 ()2-s2.0-84878111158 (Scopus ID)
    Available from: 2013-08-13 Created: 2013-08-13 Last updated: 2023-12-08Bibliographically approved
    4. Intraperitoneal metabolic consequences of supra-celiac aortic balloon occlusion versus superior mesenteric artery occlusion: an experimental animal study utilising microdialysis
    Open this publication in new window or tab >>Intraperitoneal metabolic consequences of supra-celiac aortic balloon occlusion versus superior mesenteric artery occlusion: an experimental animal study utilising microdialysis
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To investigate the effect of aortic supra-celiac balloon occlusion (ABO) and superior mesenteric artery (SMA) occlusion on abdominal visceral metabolism in an animal model by using intraperitoneal microdialysis (IPM) and laser Doppler flowmetry. Design: Prospective study in pigs

    Material and methods: Nine pigs were subjected to ABO and seven animals were subjected to SMA occlusion for one hour followed by three hours of reperfusion. Seven animals served as controls. Hemodynamic data, arterial blood samples, urinary output and intestinal mucosal blood flow (IBF) were followed hourly. Intraperitoneal (i.p) glucose, glycerol, lactate and pyruvate concentrations and lactate-pyruvate (l/p) ratio were measured by IPM.

    Results: Compared to baseline, ABO reduced IBF by 76% and decreased urinary output. SMA occlusion reduced IBF by 75% without affecting urinary output. ABO increased the i.p l/p ratio from 18 at baseline, peaking at 46 in early reperfusion. SMA occlusion and reperfusion tended to increase the i.p l/p ratio, peaking at 36 in early reperfusion. ABO increased the i.p glycerol concentration from 87 μM at baseline to 579 μM after three hours of reperfusion. SMA occlusion and reperfusion increased the i.p glycerol concentration but to a lesser degree.

    Conclusions: Supra-celiac ABO caused severe hemodynamic, renal and systemic metabolic disturbances compared to SMA occlusion, most likely due to the more extensive ischemiareperfusion injury. The intra-abdominal metabolism, measured by microdialysis, was affected both by ABO and SMA occlusion but the most severe disturbances were caused by ABO. The i.p l/p ratios and the glycerol concentrations increased during ischemia and reperfusion and may serve as markers of these events and indicate anaerobic metabolism and cell damage respectively.

    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-34962 (URN)
    Available from: 2014-05-05 Created: 2014-05-05 Last updated: 2021-08-19Bibliographically approved
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  • 36.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery and Department of Surgery.
    An Emergency Solution When Your Hybrid Suite Goes Dark: Use of a C-arm2021In: Journal of endovascular resuscitation and trauma management, ISSN 2002-7567, Vol. 5, no 1, p. 36-37Article in journal (Other academic)
  • 37.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery and Department of Surgery.
    Chimney Grafts in Acute Endovascular Aortic Repair Due to Ruptured Abdominal Aorta Aneurysm2021In: Journal of endovascular resuscitation and trauma management, ISSN 2002-7567, Vol. 5, no 2, p. 96-97Article in journal (Other academic)
  • 38.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery and Department of Surgery.
    JEVTM 10th Edition2021In: Journal of endovascular resuscitation and trauma management, ISSN 2002-7567, Vol. 5, no 1, p. 1-2Article in journal (Other academic)
  • 39.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    REBOA and EVTM in trauma2019In: Manual of Defenitive Surgical Trauma Care, CRC Press, 2019Chapter in book (Other academic)
  • 40.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    REBOA (del av EVTM)2019In: Akutkirurgisk operationsmanual: Akuta ingrepp för allmänkirurgen: tvingande, temporära, transportsäkrande och terapeutiska ingrepp / [ed] Mikael Öman, Lund: Studentlitteratur AB, 2019, p. 119-122Chapter in book (Other academic)
    Abstract [sv]

    REBOA som ny metod i akut kirurgi.

  • 41.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. 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 instability2018In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 487-489Article in journal (Refereed)
  • 42.
    Hörer, Tal M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Dept. of Cardiothoracic and Vascular surgery; Dept. of Surgery..
    Top Stent: The art of EndoVascular hybrid Trauma and bleeding Management2017Collection (editor) (Other academic)
  • 43.
    Hörer, Tal M.
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Cajander, Per
    Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, Örebro, Sweden.
    Jans, Anders
    Department of Surgery, Karlskoga Hospital, Karlskoga, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    A case of partial aortic balloon occlusion in an unstable multi-trauma patient2016In: Trauma, ISSN 1460-4086, E-ISSN 1477-0350, Vol. 18, no 2, p. 150-154Article in journal (Refereed)
    Abstract [en]

    The usage of aortic balloon occlusion or resuscitative endovascular balloon occlusion of the aorta in trauma management for bleeding control is increasing rapidly as an alternative to thoracotomy and aortic clamping. Little is known about the effects of partial occlusion of the aorta as a bridge to definitive treatment, but one of its advantages may be limited visceral organ ischemia. We describe the first known case of partial aortic balloon occlusion in trauma for reaching a targeted systolic blood pressure, which was used as an adjunctive tool in trauma management and as a bridge to definitive treatment.

  • 44.
    Hörer, Tal M
    et al.
    Örebro University Hospital.
    Hammo, Sari
    Örebro University Hospital, Örebro, Sweden.
    Lönn, Lars
    National Hospital, University of Copenhagen, Copenhagen, Denmark.
    Skoog, Per
    Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Örebro University Hospital.
    Unipuncture double-access method in emergent endovascular procedures.2013In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 8, no 3, p. 245-247Article in journal (Refereed)
    Abstract [en]

    We describe a technique to gain an additional endovascular access in acute situations in which a large-bore introducer is already inserted or in situations in which multiple accesses are impaired because of other reasons. Using an existing percutaneous femoral artery access, a second guide wire is inserted into the introducer, which is later withdrawn and applied onto one of the two guide wires. A double-wire access is then achieved. This access can be used, for example, for angiography or embolization catheters. This method might be useful in situations in which a quick and unplanned extra access is needed. It is, for example, applicable in hemodynamically unstable patients in whom percutaneous access can be difficult to obtain or in aortic endovascular procedures when an unplanned access is needed to insert an additional catheter for angiography and embolization.

  • 45.
    Hörer, Tal M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hebron, Dan
    Department of Radiology, Hillel Yaffe Medical Center, Hadera, Israel.
    Swaid, Forat
    Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel.
    Korin, Alexander
    Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
    Galili, Offer
    Department of Vascular Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
    Alfici, Ricardo
    Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel.
    Kessel, Boris
    Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
    Aorta Balloon Occlusion in Trauma: Three Cases Demonstrating Multidisciplinary Approach Already on Patient's Arrival to the Emergency Room2016In: Cardiovascular and Interventional Radiology, ISSN 0174-1551, E-ISSN 1432-086X, Vol. 39, no 2, p. 284-289Article in journal (Refereed)
    Abstract [en]

    To describe the usage of aortic balloon occlusion (ABO), based on a multidisciplinary approach in severe trauma patients, emphasizing the role of the interventional radiologist in primary trauma care.

    We briefly discuss the relevant literature, the technical aspects of ABO in trauma, and a multidisciplinary approach to the bleeding trauma patient. We describe three severely injured trauma patients for whom ABO was part of initial trauma management.

    Three severely injured multi-trauma patients were treated by ABO as a bridge to surgery and embolization. The procedures were performed by an interventional radiologist in the early stages of trauma management.

    The interventional radiologist and the multidisciplinary team approach can be activated already on severe trauma patient arrival. ABO usage and other endovascular methods are becoming more widely spread, and can be used early in trauma management, without delay, thus justifying the early activation of this multidisciplinary approach.

  • 46.
    Hörer, Tal M.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Faculty of Life Sciences, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden; Carmel Lady Davis Hospital, Technion Medical Faculty, Haifa, Israel.
    Ierardi, Anna Maria
    Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
    Carriero, Serena
    Post Graduate School of Radiology, University of Milan, Milan, Italy.
    Lanza, Carolina
    Post Graduate School of Radiology, University of Milan, Milan, Italy.
    Carrafiello, Gianpaolo
    Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital, Örebro, Sweden.
    Emergent vessel embolization for major traumatic and non-traumatic hemorrhage: Indications, tools and outcomes2023In: Seminars in Vascular Surgery, ISSN 0895-7967, E-ISSN 1558-4518, Vol. 36, no 2, p. 283-299Article, review/survey (Refereed)
    Abstract [en]

    Endovascular embolization of bleeding vessels in trauma and non-trauma patients is frequently used and is an important tool for bleeding control. It is included in the EVTM (endovascular resuscitation and trauma management) concept and its use in patients with hemodynamic instability is increasing. When the correct embolization tool is chosen, a dedicated multidisciplinary team can rapidly and effectively achieve bleeding control. In this article, we will describe the current use and possibilities for embolization of major hemorrhage (traumatic and non-traumatic) and the published data supporting these techniques as part of the EVTM concept.

  • 47.
    Hörer, Tal M.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery; Department of Surgery.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Faculty of Medicine and Health, Örebro, Sweden.
    Alternative Methods for Endovascular and Hybrid Bleeding Control2023In: Journal of Endovascular Resuscitation and Trauma Management (JEVTM), ISSN 2002-7567, Vol. 7, no 1, p. 43-44Article in journal (Other academic)
    Abstract [en]

    Puncture site or vascular access bleeding may be managed with open or endovascular methods. In this paper, we shortly describe alternative methods for endovascular and hybrid bleeding control.

  • 48.
    Hörer, Tal M.
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery; Department of Surgery.
    McGreevy, David
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Using Double Wires as a Stability Solution2023In: Journal of Endovascular Resuscitation and Trauma Management (JEVTM), ISSN 2002-7567, Vol. 7, no 1, p. 45-45Article in journal (Other academic)
    Abstract [en]

    At times, when the endovascular delivery or catheter system is unstable, two wires can be used, forming a double wire system.

  • 49.
    Hörer, Tal M.
    et al.
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    McGreevy, David
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hoencamp, Rigo
    Leiden University Medcial Centre, Leiden, The Neterlands; Alrijne Hospital, Leiderdorp, The Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands; Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
    The Concept of Endovascular Resuscitation and Trauma Management: Building the EVTM Team2020In: Endovascular Resuscitation and Trauma Management: Bleeding and Haemodynamic Control / [ed] Hörer, T., DuBose, J.J., Rasmussen, T., White, J.M., Springer, 2020, 1, p. 1-12Chapter in book (Refereed)
  • 50.
    Hörer, Tal M.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Norgren, Lars
    Örebro University, School of Health and Medical Sciences.
    Jansson, Kjell
    Region Örebro län, Örebro, Sweden.
    Complications but not obesity or diabetes mellitus have impact on the intraperitoneal lactate/pyruvate ratio measured by microdialysis2010In: Scandinavian Journal of Gastroenterology, ISSN 1502-7708, Vol. 45, no 1, p. 115-121Article in journal (Refereed)
    Abstract [en]

    Objective: Studies have shown a higher risk of postoperative complications in diabetic and obese patients. An increased intraperitoneal lactate/pyruvate ratio as measured by microdialysis has been reported before postoperative complications have been discovered. It is not known whether diabetes or obesity have any influence on the intraperitoneal metabolism (lactate/pyruvate ratio, glucose, glycerol) in relation to major abdominal surgery. The aim of this study was to investigate the postoperative intraperitoneal and subcutaneous carbohydrate and fat metabolism as measured by microdialysis in obese and diabetic patients after major abdominal surgery without postoperative complications.

    Material and methods: Seven obese patients (body mass index > 30 kg/m(2)) and six diabetic but non-obese patients were studied up to 48 h after major abdominal surgery and were compared with 31 non-diabetic, non-obese patients, all without complications. Microdialysis was performed to measure glucose, lactate, pyruvate and glycerol intraperitoneally and subcutaneously. The lactate/pyruvate ratio was calculated.

    Results: The lactate/pyruvate ratio did not differ between the groups. In the diabetic patients, glucose levels were higher intraperitoneally at both Days 1 and 2 compared to controls. Higher glycerol levels were found subcutaneously in obese patients at Day 2. CONCLUSIONS: The lactate/pyruvate ratio does not increase intraperitoneally after non-complicated major abdominal surgery in diabetic and obese patients. Obese patients have increased release of free fatty acids and glycerol subcutaneously, while diabetic patients show higher glucose levels intraperitoneally than controls.

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