Kaori Ito, MD, PhD, FACS
Assistant Professor
Teikyo University
Tokyo, Japan
Disclosure information not submitted.
Taichiro Tsunoyama, MD, PhD
Assistant professor
Teikyo University School of Medicine, Japan
Disclosure information not submitted.
Kahoko Nakazawa, MD, MPH
Clinical staff
Teikyo University School of Medicine, Japan
Disclosure information not submitted.
Tsuyoshi Nagao, MD
Clinical staff
Teikyo University School of Medicine, Japan
Disclosure information not submitted.
Ayumi Tomonaga, MD
Clinical staff
Teikyo University School of Medicine, Japan
Disclosure information not submitted.
Tomoki Kanda, MD
Clinical staff
Teikyo University School of Medicine, Japan
Disclosure information not submitted.
Hiroshi Kondo, MD, PhD
Professor
Teikyo University School of Medicine, Japan
Disclosure information not submitted.
Yasufumi Miyake, MD, PhD
Professor
Teikyo University School of Medicine, Japan
Disclosure information not submitted.
Tetsuya Sakamoto
Professor, MD, PhD
Teikyo University Hospital, Japan
Disclosure information not submitted.
Naoto Morimura, MD, PhD
Professor
Teikyo University School of Medicine, Japan
Disclosure information not submitted.
Title: Effects of the hybrid emergency room system on damage control laparotomy for blunt trauma
Introduction: The hybrid emergency room system (HERS) is a novel trauma resuscitation room equipped with an operating room setup, fluoroscopy equipment, and a CT scanner, allowing the trauma team to perform damage control laparotomy (DCL) and endovascular procedures (EVP) simultaneously. We sought to assess the effect of the HERS on the outcome in blunt trauma patients undergoing DCL for hemorrhagic shock.
Methods: A retrospective medical record review was used to identify adult blunt trauma patients who underwent DCL for hemorrhagic shock at our institution from April 2013 through June 2021. Patients were allocated into two groups: Group 1, patients who underwent DCL for hemorrhagic shock during the pre-HERS era (4/2013–6/2017); and Group 2, during the HERS era (7/2017–6/2021). Patients’ demographics; vital signs; Injury Severity Score; TRISS probability of survival (Ps); and types and timing of hemostatic procedures including DCL, EVP and Resuscitative Balloon Occlusion of the Aorta (REBOA), transfusions, and mortality were reviewed and compared between Groups 1 and 2.
Results: A total of 45 patients met the inclusion criteria: 24 patients in Group 1 and 21 in Group 2. Group 2 had lower TRISS Ps (62±37% vs. 45±28%, p=0.05). Time to the first hemostatic procedure was significantly shorter in Group 2 (71±71 minutes vs. 38±21 minutes, p< 0.01) and concurrent EVPs were performed more frequently (29% vs. 86%, p< 0.01). The REBOA was used more frequent in Group 2 than in Group 1 (25% vs 48%, p=0.11). The volume of transfusions was significantly fewer in Group 2 than in Group 1 (red blood cells: 24±22 units vs. 16±8 units, p< 0.01; fresh frozen plasma: 17±17 units vs. 15±9 units, p< 0.01). The preventable trauma death rate was 67% in Group 1 and 43% in Group 2 (p=0.11). Unexpected trauma survivor rates were not different between two groups (38% vs 42%, p< 0.99).
Conclusion: HERS improved the timeliness of hemostatic procedures including concurrent EVPs and reduced the need for transfusion. Further study is warranted to identify the effect of HERS on the outcome of patients undergoing DCL for hemorrhagic shock due to blunt trauma.