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Seo D, Heo I, Choi D, Jung K, Jung H. Efficacy of direct-to-operating room trauma resuscitation: a systematic review. World J Emerg Surg 2024; 19:3. [PMID: 38238854 PMCID: PMC10795202 DOI: 10.1186/s13017-023-00532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Hemorrhage control is a time-critical task, and recent studies have demonstrated that a shorter time to definitive care is positively associated with patient survival and functional outcomes. The concept of direct transport to the operating room was proposed in the 1960s to reduce treatment time. Some trauma centers have developed protocols for direct-to-operating room resuscitation (DOR) programs. Moreover, few studies have reported the clinical outcomes of DOR in patients with trauma; however, their clinical effect in improving the efficiency and quality of care remains unclear. In this systematic review, we aimed to consolidate all published studies reporting the effect of DOR on severe trauma and evaluate its utility. METHODS The PubMed, EMBASE, and Cochrane databases were searched from inception to April 2023, to identify all articles published in English that reported the effect of direct-to-operating room trauma resuscitation for severe trauma. The articles were reviewed as references of interest. RESULTS We reviewed six studies reporting the clinical effect of operating room trauma resuscitation. A total of 3232 patients were identified. Five studies compared the actual mortality with the predicted mortality using the trauma score and injury severity score, while one study compared mortality using propensity matching. Four studies reported that the actual survival rate for overall injuries was better than the predicted survival rate, whereas two studies reported no difference. Some studies performed subgroup analyses. Two studies showed that the survival rate for penetrating injuries was better than the predicted survival rate, and one showed that the survival rate for blunt injuries was better than the predicted survival rate. Five studies reported the time to surgical intervention, which was within 30 min. Two studies time-compared surgical intervention, which was shorter in patients who underwent DOR. CONCLUSION Implementing DOR is likely to have a beneficial effect on mortality and can facilitate rapid intervention in patients with severe shock. Future studies, possibly clinical trials, are needed to ensure a proper comparison of the efficiency.
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Affiliation(s)
- Dongmin Seo
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
- Regional Trauma Center of Southern Gyeong-Gi Province, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Inhae Heo
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
- Regional Trauma Center of Southern Gyeong-Gi Province, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Donghwan Choi
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
- Regional Trauma Center of Southern Gyeong-Gi Province, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
- Regional Trauma Center of Southern Gyeong-Gi Province, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hohyung Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
- Regional Trauma Center of Southern Gyeong-Gi Province, Ajou University School of Medicine, Suwon, Republic of Korea.
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Dalal AR, Dossabhoy S, Heng E, Yasin A, Leipzig MM, Bonham SA, Fischbein MP, Lee JT, Woo YJ, Watkins AC. Midterm Outcomes in Type A Aortic Dissection Repair With and Without Malperfusion in a Hybrid Operating Room. Semin Thorac Cardiovasc Surg 2022:S1043-0679(22)00280-5. [PMID: 36567047 DOI: 10.1053/j.semtcvs.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Treatment approach to type A aortic dissection with malperfusion, immediate open aortic repair vs upfront endovascular treatment, remains controversial. From January 2017 to July 2021, 301 consecutive type A repairs were evaluated at our institution. Starting in 2019, all type A aortic dissections were performed in a fixed-fluoroscopy, hybrid operating room. Propensity score matching was used to control baseline patient characteristics between traditional and hybrid operating room approaches. There were 144 patients in the traditional group and 157 in the hybrid group. In the hybrid group, 41% (64/157) underwent intraoperative angiograms, and of those, 58% (37/64) received at least 1 endovascular intervention. Following propensity matching, 125 patients remained in each the traditional and hybrid groups. Thirty-day survival was significantly improved in the hybrid cohort at 96.7% (122/125) as compared to the traditional cohort at 87.2% (109/125) (P = 0.002). There were no significant differences in perioperative paralysis (1.6% vs 1.6%, P > 0.9), new hemodialysis (12% vs 9.6%, P = 0.5), fasciotomy (2.4% vs 5.6%, P = 0.20, and exploratory laparotomy (1.6% vs 4.8%, P = 0.3). The hybrid operating room approach to type A aortic dissection, provides the ability to immediately assess distal malperfusion and perform endovascular interventions at the time of open aortic repair, and is associated with significantly higher 30-day and 2-year survival when compared to a stepwise repair approach in a traditional operating room.
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Affiliation(s)
- Alex R Dalal
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Shernaz Dossabhoy
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Elbert Heng
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Aleena Yasin
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Matthew M Leipzig
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Spencer A Bonham
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Jason T Lee
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - A Claire Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
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Pramodana B, Fachniadin A, Priyambodo A, Pribadi RH, Wibowo N, Luoma V. Role of hybrid operating room in management of low-velocity penetrating brain injury. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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