Journal of Trauma and Injury

Original Article

Resuscitative Endovascular Balloon occlusion of the aorta in Impending Traumatic arrest: Is It Effective?: Jae Sik Chung, Oh Hyun Kim, Seongyup Kim, Ji Young Jang, Gyo Jin An, Pil Young Jung; J Trauma Inj. 2020;33(1):23-30. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2020.001

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Purpose

Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations.

Methods

This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups.

Results

We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%.

Conclusions

Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.

Summary

Citations

Citations to this article as recorded by

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study
Joonhyeon Park, Sung Woo Jang, Byungchul Yu, Gil Jae Lee, Sung Wook Chang, Dong Hun Kim, Ye Rim Chang, Pil Young Jung
Journal of Trauma and Injury.2020; 33(3): 144. CrossRef
Pitfalls, Complications, and Necessity of Education about REBOA: A Single Regional Trauma Center Study
Sol Kim, Jae Sik Chung, Sung Woo Jang, Pil Young Jung
Journal of Trauma and Injury.2020; 33(3): 153. CrossRef

Case Reports

External Iliac Artery Transection Managed by Iliofemoral Bypass Grafting Using Temporary Balloon Occlusion: Young Un Choi, Jae Gil Lee, Kwangmin Kim, Seongyup Kim, Keumseok Bae, Ji Young Jang, Pil Young Jung, Hongjin Shim, Young Jin Youn, Il Hwan Park; J Trauma Inj. 2017;30(4):242-246. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.242

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Abstract PDF: Traumatic abdominal vessel injury is rare, but difficult to manage. Approaching the injured vessel and controlling the bleeding is very hard. We experienced the right iliac artery transection managed by iliofemoral bypass grafting using temporary balloon occlusion. Proximal occlusion of an iliac artery with a temporary balloon cab be an option or bridge technique for a definite operation in case of iliac artery rupture. So, we present our case.; Summary

Common Carotid Artery Laceration Managed by Clamping at Emergency Department: Young Un Choi, Kwangmin Kim, Seongyup Kim, Keumseok Bae, Ji Young Jang, Pil Young Jung, Hongjin Shim, Ki Youn Kwon; J Trauma Inj. 2017;30(4):197-201. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.197

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Abstract PDF: Common carotid artery laceration is a life-threatening injury by causing hypovolemic shock. Nevertheless the initial management is very difficult until definitive surgery at operation room. Before neck exploration at operation room, arterial bleeding control by compressing the bleeding point is not always effective. We experienced one case with externally penetrating injuries in zone II neck, which was operated after clamping of common carotid artery in the emergency department. Here we report this case.; Summary

Original Articles

Characteristics of Pediatric and Adolescent Trauma-Database Review of Single Level Trauma Center in Gangwon Province: Tae Han Lee, Pil Young Jung, Hye Youn Kwon, Hongjin Shim, Ji Young Jang, Keum Seok Bae, Seongyup Kim; J Trauma Inj. 2017;30(3):75-79. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.75

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Abstract PDF

PURPOSE
Although trauma is the most common cause of death under age 18, Korean national pediatric trauma data has lack of clinical data. This study is to prepare manpower resources, equipment, and make a correct policy decision on pediatric trauma victims.
METHODS
The study enrolled 528 patients under age 16 with traumatic injury visited Wonju Severance Christian Hostpital Trauma Center, from February 12, 2015 to December 31, 2016. We analyzed the distribution of gender, age, place and time of the accident, injury mechanism, injury severity, and injured organ by medical record.
RESULTS
The major injury mechanisms were blunt injury in 485 (91.90%), penetrating injury in 27 (5.10%), burn in 13 (2.50%), near drowning in 2 (0.40%), and foreign body ingestion in 1 (0.20%). Ninety-seven (18.4%) patients were injured at home and 67 (12.7%) patients were injured at school. The overall mortality rate was 1.13% (n=6). 5 mortalities were related to automobile accident and one was fall down. Mean Injury Severity Score (ISS) was 4 (2, 8). No statistical significance was observed in the mean ISS between each age group. The peak time of accident occurrence was between 16 and 17 o'clock. The mean ISS was higher in blunt injury group than penetrating injury with statistical significance (6.50±7.60 vs. 3.00±8.10; p<0.05). The most common injury site was upper extremity. Mean ISS was highest in thorax injury. However, mean ISS of thorax injury was higher with statistical significance only compared with face, neck and upper extremity injury.
CONCLUSIONS
We reported our pediatric trauma patients data of our hospital level I trauma center, which is the only one level I trauma center of Gangwon Province. These data is useful to prevent and prepare for pediatric trauma.

Summary

Citations

Citations to this article as recorded by

Age group characteristics of children who visited a regional trauma center and analysis of factors affecting the severe trauma
Hyung Won Lee, Jea Yeon Choi, Jae Ho Jang, Jin Seong Cho, Sung Youl Hyun, Woo Sung Choi, Jae-Hyug Woo
Pediatric Emergency Medicine Journal.2020; 7(2): 94. CrossRef

Relation between Blood Alcohol Concentration and Clinical Parameters in Trauma Patients: Tae Hwa Hong, Ji Young Jang, Seung Hwan Lee, Hyung Won Kim, Hong Jin Shim, Jae Gil Lee; J Trauma Inj. 2015;28(4):256-261. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.256

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the effects of blood alcohol concentration (BAC) on the clinical parameters in trauma patients.
METHODS
From January 2011 to March 2013, the records of a total of 102 trauma patients with BAC data were analyzed retrospectively. The revised trauma score (RTS), injury severity score (ISS), presence of shock, use of mechanical ventilation and blood transfusion, length of hospital stay, and mortality were collected. Patients were divided into four groups in accordance with the level of BAC: group A (<100 mg/dL), B (100~200 mg/dL), C (200~250 mg/dL), and D (>250 mg/dL). Patients were also divided into two groups depending on the presence of the shock, and gender, ISS, BAC, and presence of active bleeding were compared between these two groups.
RESULTS
No statistically significant differences in the ISS, RTS, presence of active bleeding, use of mechanical ventilation, and mortality were noted between groups A to D. However, the presence of shock was significantly higher in group D. After patients with severe chest injuries had been excluded, mechanical ventilation was found to have been applied more frequently in the higher BAC groups (C and D). A logistic regression analysis of these factors showed that extremely high BAC (>250 mg/dL) was an independent indicator of shock.
CONCLUSION
High BAC is a predicator of shock and the need for mechanical ventilation in patients with trauma, regardless of injury severity. Alcohol intoxication leads to an overestimate of the clinical condition and aggressive management for trauma patients. Thus, a guideline for the diagnosis and treatment of patients intoxicated with alcohol is necessary.; Summary

Abdominal Wall Closure Using Artificial Mesh for Patients with an Open Abdomen: Sung Whan Cha, Hong Jin Shim, Ji Young Jang, Jae Gil Lee; J Trauma Inj. 2012;25(4):172-177.

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Abstract PDF: PURPOSE
After damage control surgery, abdominal wall closure may be impossible due to increased intra-abdominal pressure (IAP), and primary closure may induce abdominal compartment syndrome. The purpose of this study was to investigate changes in the IAP and the feasibility of abdominal wall closure using artificial mesh.
METHODS
From July 2010 to July 2011, 8 patients with intra-abdominal hypertension underwent abdominal wall closure using artificial mesh. Medical data such as demographics, diagnosis, operation, IAP, postoperative complications, mortality and length of hospital stays were collected and reviewed, retrospectively. One patient was excluded because of inadequate measurement of the IAP.
RESULTS
Seven patients, 4 males and 3 females, were enrolled, and the mean age was 54.1 years old. Causes of operations were six traumatic abdominal injuries and one intra-abdominal infection. The IAP was reduced from 21.9+/-6.6 mmHg before opening the abdomen to 15.1+/-7.1 mmHg after fascial closure. Fascial closure was done on 14.9+/-17.5 days after the first operation. The mean lengths of the hospital and the intensive care unit (ICU) stays were 49.6 days and 29.7 days respectively. Operations were performed 3.1+/-1.5 times in all patients. Two patients expired, and one was transferred in a moribund state. Three patients suffered from complications, such as retroperitoneal abscesses, enterocutaneous fistulas, and bleeding that was related to the negative pressure wound therapy.
CONCLUSION
After abdominal wall closure using artificial mesh, intra-abdominal pressure was well controlled, and abdominal compartment syndrome does not occur. When the abdominal wall in patients who have intra-abdominal hypertension is closed, artificial mesh may be useful for maintaining a lower abdominal pressure. However, when negative pressure wound therapy is used, the possibility of serious complications must be kept in mind.; Summary

Prognostic Factors in Patients Who Performed Angiographic Embolization for the Bleeding from Injury of the Intraabdominal Organ and Pelvic Area: Jin Ho Lee, Ji Young Jang, Hong jin Shim, Jae Gil Lee; J Trauma Inj. 2012;25(4):166-171.

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Abstract PDF: PURPOSE
In patients with traumatic hemoperitoneum or pelvic bone fracture who underwent angiography and embolization, we want to find the prognostic factors related with mortality.
METHODS
Patients(333 patients) who visited our hospital with traumatic injury from March 2008 to April 2012 were included in this study. Only 37 patients with traumatic hemoperitoneum or pelvic bone fracture underwent angiography and embolization. A retrospective review was conducted, and Glasgow coma scale (GCS), Revised trauma score (RTS), Injury severity score (ISS), initial laboratory finding and time interval, the amount of transfusion from the arrival at the ER to the start of embolization, and the vital signs before and after procedure were checked. Stastical analysis was conducted using the Chi square and Mann-Whitney U test.
RESULTS
In univariate analysis, the amount of transfusion, the base deficit before procedure, the systolic blood pressure before and after the procedure, the GCS, the RTS and the ISS were significantly associated with prognosis. In the multivariate analysis, the ISS and the base deficit had significant association with prognosis. Of the 37 patients who underwent angiography and embolization, 31 patients needed not additional procedure (Group A) while the other 6 patients needed an additional procedure (Group B). After procedure, a statistically significant higher blood pressure was observed in Group A than in Group B. As to the difference in blood pressure before and after the procedure, a statistically significant decrease in systolic blood pressure was observed in Group B, but an increase was observed in Group A.
CONCLUSION
In traumatic hemoperitoneum or pelvic bone fracture patients who underwent angiography and embolization, GCS, ISS, RTS, transfusion amount before the procedure, initial base deficit and systolic blood pressure were factors related to mortality. When patients who underwent angiography and embolization only were compared with patients who underwent re-embolization or additional procedure after the first embolization, an increase in systolic blood pressure after embolization was a prognostic factor for successful control of bleeding.; Summary

Case Report

A Case of Cardiac Laceration due to Anterior Thoracic Stab Injury: Won Gi Woo, Ji Young Jang, Seung Hwan Lee, Chang Young Lee, Jae Gil Lee; J Trauma Inj. 2014;27(3):71-74.

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Abstract PDF: Among chest trauma patients, cardiac laceration is a rare, but severe, condition requiring prompt management. Depending on the patient's hemodynamic status, early detection rate of a cardiac laceration may or may not be occur. If a possibility of cardiac laceration exists, an emergent thoracotomy should be performed. Furthermore, patients who experience a cardiac laceration also experience different kinds of complications. Therefore, close follow-up and monitoring are required. Herein, we report a 41-year-old man with a left atrium and a left ventricle laceration caused by a thoracic stab injury.; Summary

Original Articles

The Choice of Management in Patients with Splenic Blunt Trauma: A Single Center Study: Ji Young Jang, Seung Hwan Lee, Jae Gil Lee; J Trauma Inj. 2013;26(4):280-285.

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Abstract PDF: PURPOSE
Nowadays, non-operative management increases in patients with blunt splenic injury due to development of diagnostic and interventional technique. The purpose of this study is to evaluate the management in patients with blunt splenic injury and effect of clinical state such as shock on the choice of management.
METHODS
From April 2007 to July 2013, we retrospectively reviewed the medical charts of fifty patients who had splenic injury after blunt trauma. The demographic characteristics, American Association for the Surgery of Trauma (AAST) grade of splenic injury, management method (emergency operation, angiographic embolization or observation) and clinical outcome were analyzed.
RESULTS
The mean age was 41.5+/-21.4 years and male was 44(88%). Twenty patients(40%) were in shock condition initially and five patients(10%) underwent emergency operation due to hemodynamic instability. Emergency angiographic embolization was performed in 20 patients(40%) and 25 patients were managed conservatively. When patients were divided into shock group (SG) and non-shock group (NSG), Patients in SG had significantly higher serum lactate level and base deficit than NSG (lactate; 4.5+/-3.4 mmol/L, base deficit; 5.8+/-4.4 mmol/L vs 1.9+/-1.4 mmol/L, 2.8+/-2.5 mmol/L, p=0.007, p=0.013). There was no significant difference of AAST grade and contrast blush rate in abdomen CT between two groups. Among 45 patients with non-operative management, four patients(8.9%) got delayed angiographic embolization and 3 patient died from companied organ injury.
CONCLUSION
Non-operative management can be acceptable management option in patients with splenic blunt trauma under intensive hemodynamic monitoring.; Summary

Transfer Patterns of Multiple Trauma Patients in University Hospital after Acute Phase Management: Jong Min Lee, Ji Young Jang, Seung Hwan Lee, Jae Gil Lee; J Trauma Inj. 2013;26(4):261-265.

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Abstract PDF: PURPOSE
The aim of this study is to evaluate the transfer pattern of multiple trauma patients after acute phase management and to determine whether the time between the surgeon's decision and the actual transfer correlates with the patient's insurance type.
METHODS
Three hundred ninety-two(392) multiple trauma patients visited the emergency room from January 2011 to April 2013. Among the 143 patients who were admitted by a trauma surgeon, 47 were transferred to another hospital after acute phase management. The age, gender, trauma mechanism, Revised trauma score (RTS), Injury severity score (ISS), insurance type, length of ICU stay and hospital stay were analyzed through a retrospective chart review.
RESULTS
The mean age was 47.7 years, and traffic accident was the most common mechanism(26, 55.3%). The mean RTS and ISS were 6.93 and 22.7, respectively. Twenty-five patients(53%) were covered by National health insurance, and 20 patients(42.6%) were covered by automobile insurance. Patients were transferred to primary (4.3%), secondary(80.9%), tertiary(4.3%) and care(10.6%) hospitals. The mean time from transfer decision to actual transfer was significantly longer for patients who were covered by automobile insurance than it was for patients who were covered by national health insurance (p=0.038).
CONCLUSION
An appropriate transfer system at the end of acute phase care is essential for managing trauma centers with limited staffing and facilities. In addition, the mean time from transfer decision to actual transfer seemed to be definitely related to the type of insurance covering the patient.; Summary

Management of Traumatic Pancreas Injury in Korea: Literature Review: Seung Hwan Lee, Ji Young Jang, Hongjin Shim, Jae Gil Lee; J Trauma Inj. 2013;26(3):207-213.

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Abstract PDF: PURPOSE
Traumatic pancreas injuries are rare conditions that result in high morbidity and mortality. Thus, early diagnosis and intervention are very important to manage pancreatic injuries. The purpose of this study is to review the management and outcomes of the pancreatic injuries in the Korean population.
METHODS
Original articles published from January 2001 to December 2012 and addressing the Korean population were selected by using indices such as 'pancreas injury', 'traumatic pancreas injury', and 'pancreatic trauma' to search KoreaMed and PubMed. Nine reports were selected to review the management options for surgery or endoscopic retrograde cholangio-pancreatography. We assessed the injury mechanisms, injury severities, associated injuries, types of operation, and outcomes.
RESULTS
Two hundred fifty of the 332 patients included in the 9 selected reports were men, and the mean age of all patients was 36.4 years. The main injury mechanism was traffic accidents(65.6%). Most patients had grade II or III injuries(68.9%). The most common extra-pancreatic injury site was the liver, followed by the chest and spleen. Operative management, including distal pancreatectomies(129), drainage procedures(64), pancreaticoduodenectomies( 23), and others(60), was used for 276 patients. The reported mortality rate was 10.2%, and the morbidity rate ranged from 38% to 76.9%. The average length of hospital stay was 39.5 days. Risk factors for mortality were amount of transfusion, injury severity, base deficit, age, and presence of shock.
CONCLUSION
In this study, we found neither significant data nor a consensus. If national guidelines are to be developed and established, a national data bank or registry, and nationwide data collection are required.; Summary

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