Browsing by Author "Endre Szarka"

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    Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry
    (2020-01-01) Federico Coccolini; Marco Ceresoli; David T. McGreevy; Mitra Sadeghi; Artai Pirouzram; Asko Toivola; Per Skoog; Koji Idoguchi; Yuri Kon; Tokiya Ishida; Yosuke Matsumura; Junichi Matsumoto; Viktor Reva; Mariusz Maszkowski; Paola Fugazzola; Matteo Tomasoni; Enrico Cicuttin; Luca Ansaloni; Claudia Zaghi; Maria Grazia Sibilla; Camilla Cremonini; Adam Bersztel; Eva Corina Caragounis; Mårten Falkenberg; Lauri Handolin; George Oosthuizen; Endre Szarka; Vassil Manchev; Tongporn Wannatoop; Sung Wook Chang; Boris Kessel; Dan Hebron; Gad Shaked; Miklosh Bala; Carlos A. Ordoñez; Peter Hibert-Carius; Massimo Chiarugi; Kristofer F. Nilsson; Thomas Larzon; Emiliano Gamberini; Vanni Agnoletti; Fausto Catena; Tal M. Hörer; Fundación Valle del Lili; Azienda Ospedaliera-Universitaria Pisana; Sahlgrenska Universitetssjukhuset; Ohta Nishinouchi Hospital; Soroka University Medical Center; Hille Yaffe Medical Center Israel; University of KwaZulu-Natal College of Health Sciences; University of Maryland; Helsinki University Hospital; Ospedale M. Bufalini; St. Marianna University School of Medicine; Faculty of Medicine, Siriraj Hospital, Mahidol University; Örebro Universitet; Azienda Ospedaliero - Universitaria di Parma; BG-Kliniken Bergmannstrost Halle; Military Medical Academy, Saint Petersburg; Chiba University School of Medicine; Dankook University; Hadassah University Medical Centre; Dzhanelidze Research Institute of Emergency Medicine; Hachinohe City Hospital; Rinku General Medical Center
    © 2020, Italian Society of Surgery (SIC). EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.
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    Feasibility and Clinical Outcome of Reboa in Patients with Impending Traumatic Cardiac Arrest
    (2020-08-01) David Thomas McGreevy; Fikri M. Abu-Zidan; Mitra Sadeghi; Artai Pirouzram; Asko Toivola; Per Skoog; Koji Idoguchi; Yuri Kon; Tokiya Ishida; Yosuke Matsumura; Junichi Matsumoto; Viktor Reva; Mariusz Maszkowski; Adam Bersztel; Eva Corina Caragounis; Mårten Falkenberg; Lauri Handolin; George Oosthuizen; Endre Szarka; Vassil Manchev; Tongporn Wannatoop; Sung Wook Chang; Boris Kessel; Dan Hebron; Gad Shaked; Miklosh Bala; Federico Coccolini; Luca Ansaloni; Carlos A. Ordoñez; Emanuel M. Dogan; James E. Manning; Peter Hibert-Carius; Thomas Larzon; Kristofer F. Nilsson; Tal Martin Hörer; Graduate School of Medicine; Fundación Valle del Lili; College of Medicine and Health Sciences United Arab Emirates University; Sahlgrenska Universitetssjukhuset; Ohta Nishinouchi Hospital; Soroka University Medical Center; Hille Yaffe Medical Center Israel; The University of North Carolina at Chapel Hill; University of KwaZulu-Natal College of Health Sciences; University of Maryland; Helsinki University Hospital; Ospedale M. Bufalini; St. Marianna University School of Medicine; Faculty of Medicine, Siriraj Hospital, Mahidol University; University of KwaZulu-Natal; Örebro Universitet; BG-Kliniken Bergmannstrost Halle; Military Medical Academy, Saint Petersburg; Dankook University; Hadassah University Medical Centre; Dzhanelidze Research Institute of Emergency Medicine; Hachinohe City Hospital; Rinku General Medical Center
    BACKGROUND: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may improve Systolic Blood Pressure (SBP) in hypovolemic shock. It has, however, not been studied in patients with impending traumatic cardiac arrest (ITCA). We aimed to study the feasibility and clinical outcome of REBOA in patients with ITCA using data from the ABOTrauma Registry. METHODS: Retrospective and prospective data on the use of REBOA from 16 centers globally were collected. SBP was measured both at pre- and post-REBOA inflation. Data collected included patients' demography, vascular access technique, number of attempts, catheter size, operator, zone and duration of occlusion, and clinical outcome. RESULTS: There were 74 patients in this high-risk patient group. REBOA was performed on all patients. A 7-10Fr catheter was used in 66.7% and 58.5% were placed on the first attempt, 52.1% through blind insertion and 93.2% inflated in Zone I, 64.8% for a period of 30 to 60 min, 82.1% by ER doctors, trauma surgeons, or vascular surgeons. SBP significantly improved to 90 mm Hg following the inflation of REBOA. 36.6% of the patients survived. CONCLUSIONS: Our study has shown that REBOA may be performed in patients with ITCA, SBP can be elevated, and 36.6% of the patients survived if REBOA placement is successful.