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Pil Young Jung 9 Articles
Initial Experiences of Extracorporeal Membrane Oxygenation for Trauma Patients at a Single Regional Trauma Center in South Korea
Ji Wool Ko, Il Hwan Park, Chun Sung Byun, Sung Woo Jang, Pil Young Jung
J Trauma Inj. 2021;34(3):162-169.   Published online July 28, 2021
DOI: https://doi.org/10.20408/jti.2020.0073
  • 2,761 View
  • 72 Download
AbstractAbstract PDF
Purpose

For severe lung injuries or acute respiratory distress syndrome that occurs during critical care due to trauma, extracorporeal membrane oxygenation (ECMO) may be used as a salvage treatment. This study aimed to describe the experiences at a single center with the use of ECMO in trauma patients.

Methods

We enrolled a total of 25 trauma patients who were treated with ECMO between January 2015 and December 2019 at a regional trauma center. We analyzed and compared patients’ characteristics between survivors and non-survivors through a medical chart review. We also compared the characteristics of patients between direct and indirect lung injury groups.

Results

The mean age of the 25 patients was 45.9±19.5 years, and 19 patients (76.0%) were male. The mean Injury Severity Score was 26.1±10.1. Ten patients (40.0%) had an Abbreviated Injury Scale (AIS) 3 score of 4, and six patients (24.0%) had an AIS 3 score of 5. There were 19 cases (76.6%) of direct lung injury. The mortality rate was 60.0% (n=15). Sixteen patients (64.0%) received a loading dose of heparin for the initiation of ECMO. There was no significant difference in heparin use between the survivors and non-survivors (70% in survivors vs. 60% in non-survivors, p=0.691). When comparing the direct and indirect lung injury groups, there were no significant differences in variables other than age and ECMO onset time.

Conclusions

If more evidence is gathered, risk factors and indications will be identified and we expect that more trauma patients will receive appropriate treatment with ECMO.

Summary
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
  • 4,126 View
  • 108 Download
  • 3 Citations
AbstractAbstract 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

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  • 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
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
J Trauma Inj. 2020;33(3):153-161.   Published online September 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0049
  • 5,102 View
  • 126 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure and extremely time-dependent, and the proficiency of the physician is important. Due to a lack of REBOA education programs in Republic of Korea, few physicians have been trained in the procedure. In this study, we examined how REBOA education affects clinical outcomes in a single center.

Methods

A retrospective study conducted from February 2017 to June 2020 at a regional trauma center. We collected data of patients who underwent REBOA and analyzed the factors that influenced the outcome. The patients were divided into the educated and non-educated groups (based on REBOA training received by their physicians), and the success and failure groups.

Results

A total of 24 patients underwent REBOA during the study. There were eight patients in the success group and 16 patients in the failure group. There are no significant differences between the educated and non-educated groups in sex, age, ISS, shock, injury-to-REBOA time, injury mechanism, injury sites, arrest, access site, type of catheter, type of REBOA, target Zone, mortality, and the result of REBOA. The non-educated group had a higher risk for failure compared to the educated group in multivariate analysis (odds ratio [OR] 154.64, 95% confidence interval [CI] 1.11-22.60).

Conclusions

Failure in REBOA is harmful to patients. The risk of failure is increased in the non-educated group. Physicians working in the trauma center or emergency department need to complete the REBOA education program.

Summary

Citations

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  • 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
  • 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
    Journal of Trauma and Injury.2023; 36(1): 3.     CrossRef
Hidden Hematologic Disease in Trauma Patients: A Report of Two Cases
Sung Woo Jang, Pil Young Jung
J Trauma Inj. 2020;33(2):112-118.   Published online June 17, 2020
DOI: https://doi.org/10.20408/jti.2020.016
  • 4,447 View
  • 76 Download
AbstractAbstract PDF

In trauma patients, coagulopathy and abnormal increases or decreases in cell counts are frequently observed, and are associated with high mortality and morbidity in the acute phase of trauma. Because major trauma is often life-threatening, and hematologic abnormalities are multi-factorial and transient, major blood loss is usually suspected to be the primary cause of these abnormalities, and much time and cost may be spent attempting to identify a focus of hemorrhage that might or might not actually exist. Persistent abnormalities in the complete blood count, however, require clinical suspicion of other hematologic diseases to minimize improper transfusions and to improve outcomes, including mortality. Physicians at trauma centers should be familiar with the clinical characteristics of hematologic diseases and should consider these diseases in trauma patients. In this report, we present cases of two hematologic disorders found in trauma patients: autoimmune hemolytic anemia induced by systemic lupus erythematosus and myelodysplastic syndrome.

Summary
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
  • 5,802 View
  • 166 Download
  • 1 Citations
PDF
Summary

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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
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
  • 17,843 View
  • 1,012 Download
  • 2 Citations
AbstractAbstract 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

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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
  • 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
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
  • 4,810 View
  • 140 Download
  • 2 Citations
AbstractAbstract PDF
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

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  • 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
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
  • 3,773 View
  • 39 Download
AbstractAbstract 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
  • 18,814 View
  • 92 Download
AbstractAbstract 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

J Trauma Inj : Journal of Trauma and Injury