Combined computed tomography and C-arm resuscitation room system (CTCARM) is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic trauma
Objectives Severe pelvic fracture concomitant with massive bleeding is potentially lethal, and intervention for hemorrhage control still depends on institutional supplies. With the recent installation of a CT and C-arm combined resuscitation room system (CTCARM) for treatment of trauma patients in o...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-11-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/8/1/e001153.full |
| _version_ | 1797367457257619456 |
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| author | Tetsuro Nishimura Kenichiro Uchida Masahiro Miyashita Hiromasa Yamamoto Yasumitsu Mizobata Ryo Deguchi Hoshi Himura Hiroyuki Yoshitake Akihiro Kawamoto Yuki Saoyama |
| author_facet | Tetsuro Nishimura Kenichiro Uchida Masahiro Miyashita Hiromasa Yamamoto Yasumitsu Mizobata Ryo Deguchi Hoshi Himura Hiroyuki Yoshitake Akihiro Kawamoto Yuki Saoyama |
| author_sort | Tetsuro Nishimura |
| collection | DOAJ |
| description | Objectives Severe pelvic fracture concomitant with massive bleeding is potentially lethal, and intervention for hemorrhage control still depends on institutional supplies. With the recent installation of a CT and C-arm combined resuscitation room system (CTCARM) for treatment of trauma patients in our institution, the strategic process and options for hemorrhage control after pelvic fracture have changed. We retrospectively reviewed the procedures we performed and their outcomes.Methods The CTCARM was installed in our trauma resuscitation room in April 2020. Patients who were diagnosed as having pelvic fracture and underwent interventional radiology for hemorrhage control within 2.5 hours after arrival were compared before and after CTCARM installation. We reviewed the time process for hemorrhage control, treatment options performed, blood products used and their outcomes.Results Included in this study were 56 patients treated between 2016 and 2022, of whom 36 patients were treated before (original group) and 20 patients after CTCARM installation (CTCARM group). Patient characteristics and vital signs at admission were not statistically different. Preperitoneal pelvic packing was performed significantly more frequently in the original group (p<0.01), whereas resuscitative endovascular balloon occlusion of the aorta use was much more frequent in the CTCARM group (p=0.02). Although the times from admission to first angiography (p=0.014) and to complete hemostasis (p=0.02) were significantly shorter in the CTCARM group, mortality was not statistically different. Four preventable trauma deaths occurred in the original group, but there were none in the CTCARM group. Six unexpected survivors were observed in the original group and four in the CTCARM group.Conclusions Although the CTCARM had no direct effects on patient mortality for now, it has allowed us to accelerate the treatment time process, shorten preperitoneal pelvic packing procedural time, and potentially avoid subsequent preventable trauma deaths.Level of evidence Level IV. |
| first_indexed | 2024-03-08T17:18:37Z |
| format | Article |
| id | doaj.art-2b9dc44021d34163a4b28e4a4b0ad983 |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2024-03-08T17:18:37Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-2b9dc44021d34163a4b28e4a4b0ad9832024-01-03T09:40:09ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762023-11-018110.1136/tsaco-2023-001153Combined computed tomography and C-arm resuscitation room system (CTCARM) is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic traumaTetsuro Nishimura0Kenichiro Uchida1Masahiro Miyashita2Hiromasa Yamamoto3Yasumitsu Mizobata4Ryo Deguchi5Hoshi Himura6Hiroyuki Yoshitake7Akihiro Kawamoto8Yuki Saoyama9Department of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanDepartment of Traumatology and Critical Care Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, JapanObjectives Severe pelvic fracture concomitant with massive bleeding is potentially lethal, and intervention for hemorrhage control still depends on institutional supplies. With the recent installation of a CT and C-arm combined resuscitation room system (CTCARM) for treatment of trauma patients in our institution, the strategic process and options for hemorrhage control after pelvic fracture have changed. We retrospectively reviewed the procedures we performed and their outcomes.Methods The CTCARM was installed in our trauma resuscitation room in April 2020. Patients who were diagnosed as having pelvic fracture and underwent interventional radiology for hemorrhage control within 2.5 hours after arrival were compared before and after CTCARM installation. We reviewed the time process for hemorrhage control, treatment options performed, blood products used and their outcomes.Results Included in this study were 56 patients treated between 2016 and 2022, of whom 36 patients were treated before (original group) and 20 patients after CTCARM installation (CTCARM group). Patient characteristics and vital signs at admission were not statistically different. Preperitoneal pelvic packing was performed significantly more frequently in the original group (p<0.01), whereas resuscitative endovascular balloon occlusion of the aorta use was much more frequent in the CTCARM group (p=0.02). Although the times from admission to first angiography (p=0.014) and to complete hemostasis (p=0.02) were significantly shorter in the CTCARM group, mortality was not statistically different. Four preventable trauma deaths occurred in the original group, but there were none in the CTCARM group. Six unexpected survivors were observed in the original group and four in the CTCARM group.Conclusions Although the CTCARM had no direct effects on patient mortality for now, it has allowed us to accelerate the treatment time process, shorten preperitoneal pelvic packing procedural time, and potentially avoid subsequent preventable trauma deaths.Level of evidence Level IV.https://tsaco.bmj.com/content/8/1/e001153.full |
| spellingShingle | Tetsuro Nishimura Kenichiro Uchida Masahiro Miyashita Hiromasa Yamamoto Yasumitsu Mizobata Ryo Deguchi Hoshi Himura Hiroyuki Yoshitake Akihiro Kawamoto Yuki Saoyama Combined computed tomography and C-arm resuscitation room system (CTCARM) is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic trauma Trauma Surgery & Acute Care Open |
| title | Combined computed tomography and C-arm resuscitation room system (CTCARM) is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic trauma |
| title_full | Combined computed tomography and C-arm resuscitation room system (CTCARM) is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic trauma |
| title_fullStr | Combined computed tomography and C-arm resuscitation room system (CTCARM) is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic trauma |
| title_full_unstemmed | Combined computed tomography and C-arm resuscitation room system (CTCARM) is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic trauma |
| title_short | Combined computed tomography and C-arm resuscitation room system (CTCARM) is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic trauma |
| title_sort | combined computed tomography and c arm resuscitation room system ctcarm is associated with decreased time to definitive hemostasis and reduces preperitoneal pelvic packing maneuvers in severe pelvic trauma |
| url | https://tsaco.bmj.com/content/8/1/e001153.full |
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