1
|
Mizuno Y, Miyake T, Okada H, Ishihara T, Kanda N, Ichihashi M, Kamidani R, Fukuta T, Yoshida T, Nagata S, Kawada H, Matsuo M, Yoshida S, Ogura S. A short decision time for transcatheter embolization can better associate mortality in patients with pelvic fracture: a retrospective study. Front Med (Lausanne) 2024; 10:1329167. [PMID: 38259838 PMCID: PMC10800860 DOI: 10.3389/fmed.2023.1329167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Early use of hemostasis strategies, transcatheter arterial embolization (TAE) is critical in cases of pelvic injury because of the risk of hemorrhagic shock and other fatal injuries. We investigated the influence of delays in TAE administration on mortality. Methods Patients admitted to the Advanced Critical Care Center at Gifu University with pelvic injury between January 2008 and December 2019, and who underwent acute TAE, were retrospectively enrolled. The time from when the doctor decided to administer TAE to the start of TAE (needling time) was defined as "decision-TAE time." Results We included 158 patients, of whom 23 patients died. The median decision-TAE time was 59.5 min. Kaplan-Meier curves for overall survival were compared between patients with decision-TAE time above and below the median cutoff value; survival was significantly better for patients with values below the median cutoff value (p = 0.020). Multivariable Cox proportional hazards regression analysis revealed that the longer the decision-TAE time, the higher the risk of mortality (p = 0.031). TAE duration modified the association between decision-TAE time and overall survival (p = 0.109), as shorter TAE duration (procedure time) was associated with the best survival rate (p for interaction = 0.109). Conclusion Decision-TAE time may play a key role in establishing resuscitation procedures in patients with pelvic fracture, and efforts to shorten this time should be pursued.
Collapse
Affiliation(s)
- Yosuke Mizuno
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takahito Miyake
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hideshi Okada
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
- Center for One Medicine Innovative Translational Research, Gifu University Institute for Advanced Study, Gifu, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University, Gifu, Japan
| | - Norihide Kanda
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahiro Ichihashi
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ryo Kamidani
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tetsuya Fukuta
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takahiro Yoshida
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shoma Nagata
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shozo Yoshida
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
- Abuse Prevention Center, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|
2
|
DuBose JJ, Burlew CC, Joseph B, Keville M, Harfouche M, Morrison J, Fox CJ, Mooney J, O'Toole R, Slobogean G, Marchand LS, Demetriades D, Werner NL, Benjamin E, Costantini T. Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control. J Trauma Acute Care Surg 2021; 91:e93-e103. [PMID: 34238857 DOI: 10.1097/ta.0000000000003331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Major pelvic hemorrhage remains a considerable challenge of modern trauma care associated with mortality in over a third of patients. Efforts to improve outcomes demand continued research into the optimal employment of both traditional and newer hemostatic adjuncts across the full spectrum of emergent care environments. The purpose of this review is to provide a concise description of the rationale for and effective use of currently available adjuncts for the control of pelvic hemorrhage. In addition, the challenges of defining the optimal order and algorithm for employment of these adjuncts will be outlined. LEVEL OF EVIDENCE Review, level IV.
Collapse
Affiliation(s)
- Joseph J DuBose
- From the R Adams Cowley Shock Trauma Center (J.J.D., M.K., M.H., J.M., C.J.F., R.O., G.S.), University of Maryland Medical System, Baltimore, Maryland; Department of Surgery (C.C.B., N.L.W.), Denver Health Medical Center, Denver, Colorado; Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery (B.J.), College of Medicine, University of Arizona, Tucson, Arizona; Baylor University Medical Center (J.M.), Dallas, Texas; Department of Orthopedic Surgery (L.S.M.), University of Utah, Salt Lake City, Utah; Division of Trauma and Surgical Critical Care (D.D., E.B.), LAC+USC Medical Center, University of Southern California, Los Angeles, California; Trauma/Surgical Critical Care (T.C.), Grady Memorial Hospital/Emory University School of Medicine, Atlanta, Georgia; and Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (T.C.), University of California San Diego School of Medicine, San Diego, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|