Journal of Trauma and Injury

Original Article

Analysis of procedural performance after a pilot course on endovascular training for resuscitative endovascular balloon occlusion of the aorta: Sung Wook Chang, Dong Hun Kim, Dae Sung Ma, Ye Rim Chang; J Trauma Inj. 2023;36(1):3-7. Published online September 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0022

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Purpose
As resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed in an extremely emergent situation, achieving competent clinical practice is mandatory. Although there are several educational courses that teach the REBOA procedure, there have been no reports evaluating the impact of training on clinical practice. Therefore, this study is aimed to evaluate the effects of the course on procedural performance during resuscitation and on clinical outcomes.
Methods
Patients who were managed at a regional trauma center in Dankook University Hospital from August 2016 to February 2018 were included and were grouped as precourse (August 2016–August 2017, n=9) and postcourse (September 2017–February 2018, n=9). Variables regarding injury, parameters regarding REBOA procedure, morbidity, and mortality were prospectively collected and reviewed for comparison between the groups.
Results
Demographics and REBOA variables did not differ between groups. The time required from arterial puncture to balloon inflation was significantly shortened from 9.0 to 5.0 minutes (P=0.003). There were no complications associated with REBOA after the course. Mortality did not show any statistical difference before and after the course.
Conclusions
The endovascular training for REBOA pilot course, which uses a modified form of flipped learning, realistic simulation of ultrasound-guided catheter insertion and balloon manipulation, and competence assessment, significantly improved procedural performance during resuscitation of trauma patients.

Summary

Citations

Citations to this article as recorded by

Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study
Byungchul Yu, Jayun Cho, Byung Hee Kang, Kyounghwan Kim, Dong Hun Kim, Sung Wook Chang, Pil Young Jung, Yoonjung Heo, Wu Seong Kang
Scientific Reports.2024;[Epub] CrossRef

Case Reports

Extraanatomic bypass grafting in a patient with an infected femoral defect caused by a rollover accident: a case report: Dae Sung Ma, Dong Hun Kim, Jae-Wook Ryu, Sung Wook Chang; J Trauma Inj. 2022;35(Suppl 1):S23-S26. Published online July 21, 2022; DOI: https://doi.org/10.20408/jti.2021.0005

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Abstract PDF: A 59-year-old male patient presented to the emergency department after a tractor rollover accident. His Injury Severity Score was 41 points. He had multiple pelvic bone fractures and a left common femoral artery injury with soft tissue loss. The injured arteries with skin defect were initially managed with endarterectomy and primary repair. However, the sepsis secondary to the infection from a skin defect became uncontrolled. The infected wound developed massive hemorrhage from the repaired arteries. Supportive measures were initiated to achieve hemostasis but unsuccessful. We performed an anastomosis with a prosthetic graft from the common iliac artery to the femoral artery above the knee, avoiding the wound through the lateral side of the anterior superior iliac spine. After revascularization, the patient recovered uneventfully. An extraanatomic graft reconstruction should be considered early when the autologous vein is unsuitable.; Summary

Extra-Pericardial Tamponade due to Internal Thoracic Artery Rupture after Blunt Trauma: A Case Report: Dongsub Noh, Sung Wook Chang, Dae Sung Ma; J Trauma Inj. 2021;34(3):183-186. Published online September 30, 2021; DOI: https://doi.org/10.20408/jti.2021.0045

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Abstract PDF

Cardiac tamponade is an acute life-threatening condition that predominantly involves the intra-pericardial space; however, an expanding mediastinal hematoma can also sometimes cause cardiac tamponade. Here we describe the case of a 45-year-old male driver in whom a traffic accident resulted in rupture of the left internal thoracic artery (ITA), extra-pericardial hematoma, and sternal fracture. After resuscitation, he was scheduled to undergo angio-embolization to repair the ruptured left ITA, but he suddenly developed cardiac tamponade that required a decompressive sternotomy. Nevertheless, the patient had an uncomplicated recovery, and this case suggests that extra-pericardial cardiac tamponade should be considered as a possible consequence of retro-sternal hematoma due to traumatic ITA rupture.

Summary

Citations

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Traumatic Pseudoaneurysms of the Internal Mammary Artery: Two Cases and Percutaneous Intervention
Kayla A. Aikins, Zoé N. Anderson, Timothy M. Koci
Diagnostics.2023; 14(1): 63. CrossRef

Special Article

Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology: Sung Wook Chang, Kang Kook Choi, O Hyun Kim, Maru Kim, Gil Jae Lee; J Trauma Inj. 2020;33(4):207-218. Published online December 31, 2020; DOI: https://doi.org/10.20408/jti.2020.0084

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Abstract PDF: The following recommendations are presented herein: All trauma patients admitted to the resuscitation room should be constantly (or periodically) monitored for parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, electrocardiography, Glasgow Coma Scale, and pupil reflex (1C). Chest AP and pelvic AP should be performed as the standard initial trauma series for severe trauma patients (1B). In patients with severe hemodynamically unstable trauma, it is recommended to perform extended focused assessment with sonography for trauma (eFAST) as an initial examination (1B). In hemodynamically stable trauma patients, eFAST can be considered as the initial examination (2B). For the diagnosis of suspected head trauma patients, brain computed tomography (CT) should be performed as an initial examination (1B). Cervical spine CT should be performed as an initial imaging test for patients with suspected cervical spine injury (1C). It is not necessary to perform chest CT as an initial examination in all patients with suspected chest injury, but in cases of suspected vascular injury in patients with thoracic or high-energy damage due to the mechanism of injury, chest CT can be considered for patients in a hemodynamically stable condition (2B). CT of the abdomen is recommended for patients suspected of abdominal trauma with stable vital signs (1B). CT of the abdomen should be considered for suspected pelvic trauma patients with stable vital signs (2B). Whole-body CT can be considered in patients with suspicion of severe trauma with stable vital signs (2B). Magnetic resonance imaging can be considered in hemodynamically stable trauma patients with suspected spinal cord injuries (2B).; Summary

Original Article

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; J Trauma Inj. 2020;33(3):144-152. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0051

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Abstract PDF

Purpose

This retrospective multicenter study analyzed trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) in the Republic of Korea.

Methods

This study was conducted from February 2017 to May 2018 at three regional trauma centers in the Republic of Korea. The patients were divided into two groups (cardiopulmonary resuscitation [CPR] and No-CPR) for comparative analysis based on two criteria (complication and mortality) for logistic regression analysis (LRA).

Results

There were significant differences between the CPR and No-CPR groups in mortality (p=0.003) and treatment administered (p=0.016). By LRA for complications, total occlusion has significantly lesser risk than intermittent or partial occlusion in both univariate (odds ratio [OR] 0.06, 95% confidence interval [CI] 0.00-0.36, p=0.01) and multivariate (OR 0.05, 95% CI 0.00-0.38, p=0.01) analyses. The Rescue had a higher risk than the Coda or Reliant in univariate analysis (OR 4.91, 95% CI 1.14-34.25, p=0.05); however, it was not statistically significant in multivariate analysis (OR 6.98, 95% CI 1.03-74.52, p=0.07). By LRA for mortality, the CPR group was the only variable that had a significantly higher risk of mortality than the No-CPR group in both univariate (OR 17.59, 95% CI 3.05-335.25, p=0.01), and multivariate (OR 24.92, 95% CI 3.77-520.51, p=0.01) analyses.

Conclusions

This study was conducted in the early stages of REBOA implementation in the Republic of Korea and showed conflicting results from studies conducted by multiple institutions. Therefore, additional research with more accumulated data is needed.

Summary

Citations

Citations to this article as recorded by

Complications associated with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA): an updated review
Marcelo Augusto Fontenelle Ribeiro Junior, Salman M Salman, Sally M Al-Qaraghuli, Farah Makki, Riham A Abu Affan, Shahin Reza Mohseni, Megan Brenner
Trauma Surgery & Acute Care Open.2024; 9(1): e001267. CrossRef
Contemporary Utilization and Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Noncompressible Torso Hemorrhage in Korea: A Retrospective Multi-Center Study
Yoonjung Heo, Sung Wook Chang, Byungchul Yu, Byung Hee Kang, Pil Young Jung, Kyounghwan Kim, Dong Hun Kim
Journal of Acute Care Surgery.2024; 14(1): 16. CrossRef
On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma
A. I. Zhukov, N. N. Zadneprovsky, P. A. Ivanov, L. S. Kokov
Russian Sklifosovsky Journal "Emergency Medical Ca.2024; 13(1): 14. CrossRef
Editor's Choice – Systematic Review and Meta-Analysis of Lower Extremity Vascular Complications after Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): An Inevitable Concern?
Megan Power Foley, Stewart R. Walsh, Nathalie Doolan, Paul Vulliamy, Morgan McMonagle, Christopher Aylwin
European Journal of Vascular and Endovascular Surg.2023; 66(1): 103. CrossRef
Early experience with resuscitative endovascular balloon occlusion of the aorta for unstable pelvic fractures in the Republic of Korea: a multi-institutional study
Dong Hun Kim, Jonghwan Moon, Sung Wook Chang, Byung Hee Kang
European Journal of Trauma and Emergency Surgery.2023; 49(6): 2495. CrossRef
Comparison between external fixation and pelvic binder in patients with pelvic fracture and haemodynamic instability who underwent various haemostatic procedures
Ji Young Jang, Keum Soek Bae, Byung Hee Kang, Gil Jae Lee
Scientific Reports.2022;[Epub] CrossRef

Special Article

Part 3. Clinical Practice Guideline for Airway Management and Emergency Thoracotomy for Trauma Patients from the Korean Society of Traumatology: Chan Yong Park, O Hyun Kim, Sung Wook Chang, Kang Kook Choi, Kyung Hak Lee, Seong Yup Kim, Maru Kim, Gil Jae Lee; J Trauma Inj. 2020;33(3):195-203. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0050

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Abstract PDF: The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).; Summary

Review Article

Educational Simulation Videos for Performing Resuscitative Endovascular Balloon Occlusion of the Aorta: Sung Wook Chang, Dong Hun Kim, Ye Rim Chang; J Trauma Inj. 2020;33(3):140-143. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0035

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Abstract PDF Supplementary Material

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been accepted as an adjunct procedure for non-compressible torso hemorrhage in patients with hemorrhagic shock. With appropriate indications, REBOA should be performed for resuscitation regardless of the physician’s specialty. Despite its effectiveness in traumatized patients with hemorrhagic shock, performing REBOA has been challenging due to physicians’ lack of experience. Even though training in endovascular skills is mandatory, many physicians cannot undergo sufficient training because of the limited number of endovascular simulation programs. Herein, we share simulation video clips, including those of a vascular circuit model for simulation; sheath preparation; long guidewire and balloon catheter preparation; ultrasound-guided arterial access; sheath insertion or upsizing; and balloon positioning, inflation, and migration. The aim of this study was to provide educational video clips to improve physicians’ endovascular skills for REBOA.

Summary

Citations

Citations to this article as recorded by

Feasibility and Clinical Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Traumatic Shock: A Single-Center 5-Year Experience
Gyeongho Lee, Dong Hun Kim, Dae Sung Ma, Seok Won Lee, Yoonjung Heo, Hancheol Jo, Sung Wook Chang
Journal of Chest Surgery.2023; 56(2): 108. CrossRef
Early experience with resuscitative endovascular balloon occlusion of the aorta for unstable pelvic fractures in the Republic of Korea: a multi-institutional study
Dong Hun Kim, Jonghwan Moon, Sung Wook Chang, Byung Hee Kang
European Journal of Trauma and Emergency Surgery.2023; 49(6): 2495. CrossRef

Case Report

Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient: Yoonjung Heo, Sung Wook Chang, Dong Hun Kim; J Trauma Inj. 2020;33(3):170-174. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0012

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Abstract PDF: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.; Summary

Special Article

Part 2. Clinical Practice Guideline for Trauma Team Composition and Trauma Cardiopulmonary Resuscitation from the Korean Society of Traumatology: Oh Hyun Kim, Seung Je Go, Oh Sang Kwon, Chan-Yong Park, Byungchul Yu, Sung Wook Chang, Pil Young Jung, Gil Jae Lee; J Trauma Inj. 2020;33(2):63-73. Published online June 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0020

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Summary

Citations

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An Artificial Intelligence Model for Predicting Trauma Mortality Among Emergency Department Patients in South Korea: Retrospective Cohort Study
Seungseok Lee, Wu Seong Kang, Do Wan Kim, Sang Hyun Seo, Joongsuck Kim, Soon Tak Jeong, Dong Keon Yon, Jinseok Lee
Journal of Medical Internet Research.2023; 25: e49283. CrossRef

Original Articles

Clinical Practice Guideline for the Treatment of Traumatic Shock Patients from the Korean Society of Traumatology: Pil Young Jung, Byungchul Yu, Chan-Yong Park, Sung Wook Chang, O Hyun Kim, Maru Kim, Junsik Kwon, Gil Jae Lee; J Trauma Inj. 2020;33(1):1-12. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2020.015

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Abstract PDF

Purpose

Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent.

Methods

Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument.

Results

Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80–90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100–110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient’s initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C).

Conclusions

This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

Summary

Citations

Citations to this article as recorded by

An Artificial Intelligence Model for Predicting Trauma Mortality Among Emergency Department Patients in South Korea: Retrospective Cohort Study
Seungseok Lee, Wu Seong Kang, Do Wan Kim, Sang Hyun Seo, Joongsuck Kim, Soon Tak Jeong, Dong Keon Yon, Jinseok Lee
Journal of Medical Internet Research.2023; 25: e49283. CrossRef
Nonselective versus Selective Angioembolization for Trauma Patients with Pelvic Injuries Accompanied by Hemorrhage: A Meta-Analysis
Hyunseok Jang, Soon Tak Jeong, Yun Chul Park, Wu Seong Kang
Medicina.2023; 59(8): 1492. CrossRef

Quality Improvement in the Trauma Intensive Care Unit Using a Rounding Checklist: The Implementation Results: Ye Rim Chang, Sung Wook Chang, Dong Hun Kim, Jeongseok Yun, Jung Ho Yun, Seok Won Lee, Han Cheol Jo, Seok Ho Choi; J Trauma Inj. 2017;30(4):113-119. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.113

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Abstract PDF: Purpose
Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated.
Methods
A checklist consisting of 12 components (feeding, analgesia, sedation, thromboembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium monitoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period.
Results
Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3.
Conclusions
An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.; Summary

Management of Femoropopliteal Vascular Injuries after Trauma: Surgical Outcomes: Sung Wook Chang, Sun Han, Kyoung Min Ryu, Jae Wook Ryu; J Trauma Inj. 2015;28(1):15-20. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.15

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Abstract PDF: PURPOSE
Vascular injuries caused by traffic, industrial accidents and by outside activities have increased in Korea. Especially, vascular injuries to the extremities can lead to limb loss and even mortality if they are not appropriately treated. The aim of the study was to evaluate the surgical outcomes of femoropopliteal vascular management after trauma.
METHODS
The medical records of 12 patients with femoropopliteal vascular injuries who were treated at Dankook University Hospital from 2011 to 2013 were reviewed. Iatrogenic vascular injuries were excluded. The clinical data including the causes of injury, associated injuries and surgical outcomes were analyzed retrospectively.
RESULTS
All patients were male, with a mean age of 46.8+/-16.3 years (range: 26~69 years). The causes of vascular injuries were four traffic accidents, three industrial accidents, two iron plates, one outside activity, one glass injury and one knife injury. The average transit time between the place of the accident place and the emergency department was 3.0+/-2.1 (0.5~12.5) hours, and the average preparation time for surgery was 8.0+/-6.7 (1.7~23.3) hours. The anatomic injuries included the popliteal vessel in seven cases and the femoral vessel in five cases. The average Injury Severity Score (ISS) was 12.0+/-5.0 (5~17), and the average Mangled Extremity Severity Score (MESS) was 5.7+/-2.1 (2~9). The operation methods were four interposition grafts, three end-to-end anastomoses, two direct repairs and three patch angioplasties. One case required amputation of the injured extremity.
CONCLUSION
Early recognition and revascularization of the injured vessel are mandatory to reduce limb loss and to obtain satisfactory outcomes. Therefore, careful/rapid evaluation of the vascular injuries and timely/successful surgical treatment are the keys to salvaging an injured limb.; Summary

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