Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group
Abstract Background Intra-operative internal carotid artery (ICA) injury during transnasal endoscopic surgery is a potentially catastrophic event. Such an injury is life-threatening in the immediate setting, with a reported peri-operative mortality rate of 10%. Nasal packing, muscle patches, direct...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40463-022-00582-w |
| _version_ | 1797969345448509440 |
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| author | Amr F. Hamour Frederick Laliberte Vikram Padhye Eric Monteiro Ronit Agid John M. Lee Ian J. Witterick Allan D. Vescan |
| author_facet | Amr F. Hamour Frederick Laliberte Vikram Padhye Eric Monteiro Ronit Agid John M. Lee Ian J. Witterick Allan D. Vescan |
| author_sort | Amr F. Hamour |
| collection | DOAJ |
| description | Abstract Background Intra-operative internal carotid artery (ICA) injury during transnasal endoscopic surgery is a potentially catastrophic event. Such an injury is life-threatening in the immediate setting, with a reported peri-operative mortality rate of 10%. Nasal packing, muscle patches, direct vessel closure, and endovascular techniques have been described as useful strategies for managing ICA bleeds. The objective of this study was to develop a formalized management protocol for intra-operative ICA injury through engagement with a multi-disciplinary panel. Methods A modified Delphi method including literature review, iterative rounds of stakeholder feedback, and expert panel discussions was used to develop a management protocol for ICA injury during transnasal endoscopic surgery. The 10-person multi-disciplinary panel included otolaryngologists, neurosurgeons, interventional neuroradiologists, anesthesiologists, and operating room nursing staff. Results After three rounds of stakeholder engagement with the expert panel, consensus was reached on important elements to include within the protocol. The protocol was divided in three categories: Alert, Control, and Transfer. ‘Alert’ focusses on early communication with anesthesia and nursing staff. ‘Control’ focusses on techniques to expose the injury and obtain hemostasis or adequate tamponade. Lastly, ‘Transfer’ describes the process of contacting neuro-interventional radiology and safely transferring the patient. A one-page handout of the protocol was developed for placement in operating theatres. Conclusion Due to the life-threatening nature of ICA injury, it is imperative that endoscopic sinus and skull base surgeons are prepared to manage this complication. Using a modified Delphi method with a multidisciplinary expert panel, a protocol for management of intra-operative ICA injury was developed. Graphical Abstract |
| first_indexed | 2024-04-11T02:59:40Z |
| format | Article |
| id | doaj.art-8acffcc219ef44379cfd3fc47aa3f085 |
| institution | Directory Open Access Journal |
| issn | 1916-0216 |
| language | English |
| last_indexed | 2024-04-11T02:59:40Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj.art-8acffcc219ef44379cfd3fc47aa3f0852023-01-02T14:18:52ZengBMCJournal of Otolaryngology - Head and Neck Surgery1916-02162022-07-015111810.1186/s40463-022-00582-wDevelopment of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working groupAmr F. Hamour0Frederick Laliberte1Vikram Padhye2Eric Monteiro3Ronit Agid4John M. Lee5Ian J. Witterick6Allan D. Vescan7Department of Otolaryngology – Head and Neck Surgery, Temerty Faculty of Medicine, University of TorontoDepartment of Otolaryngology – Head and Neck Surgery, Temerty Faculty of Medicine, University of TorontoDepartment of Otolaryngology – Head and Neck Surgery, Temerty Faculty of Medicine, University of TorontoDepartment of Otolaryngology – Head and Neck Surgery, Temerty Faculty of Medicine, University of TorontoDivision of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health NetworkDepartment of Otolaryngology – Head and Neck Surgery, Temerty Faculty of Medicine, University of TorontoDepartment of Otolaryngology – Head and Neck Surgery, Temerty Faculty of Medicine, University of TorontoDepartment of Otolaryngology – Head and Neck Surgery, Temerty Faculty of Medicine, University of TorontoAbstract Background Intra-operative internal carotid artery (ICA) injury during transnasal endoscopic surgery is a potentially catastrophic event. Such an injury is life-threatening in the immediate setting, with a reported peri-operative mortality rate of 10%. Nasal packing, muscle patches, direct vessel closure, and endovascular techniques have been described as useful strategies for managing ICA bleeds. The objective of this study was to develop a formalized management protocol for intra-operative ICA injury through engagement with a multi-disciplinary panel. Methods A modified Delphi method including literature review, iterative rounds of stakeholder feedback, and expert panel discussions was used to develop a management protocol for ICA injury during transnasal endoscopic surgery. The 10-person multi-disciplinary panel included otolaryngologists, neurosurgeons, interventional neuroradiologists, anesthesiologists, and operating room nursing staff. Results After three rounds of stakeholder engagement with the expert panel, consensus was reached on important elements to include within the protocol. The protocol was divided in three categories: Alert, Control, and Transfer. ‘Alert’ focusses on early communication with anesthesia and nursing staff. ‘Control’ focusses on techniques to expose the injury and obtain hemostasis or adequate tamponade. Lastly, ‘Transfer’ describes the process of contacting neuro-interventional radiology and safely transferring the patient. A one-page handout of the protocol was developed for placement in operating theatres. Conclusion Due to the life-threatening nature of ICA injury, it is imperative that endoscopic sinus and skull base surgeons are prepared to manage this complication. Using a modified Delphi method with a multidisciplinary expert panel, a protocol for management of intra-operative ICA injury was developed. Graphical Abstracthttps://doi.org/10.1186/s40463-022-00582-wComplicationsEndoscopic surgeryRhinologySkull baseEndovascular treatment |
| spellingShingle | Amr F. Hamour Frederick Laliberte Vikram Padhye Eric Monteiro Ronit Agid John M. Lee Ian J. Witterick Allan D. Vescan Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group Journal of Otolaryngology - Head and Neck Surgery Complications Endoscopic surgery Rhinology Skull base Endovascular treatment |
| title | Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group |
| title_full | Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group |
| title_fullStr | Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group |
| title_full_unstemmed | Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group |
| title_short | Development of a management protocol for internal carotid artery injury during endoscopic surgery: a modified Delphi method and single-center multidisciplinary working group |
| title_sort | development of a management protocol for internal carotid artery injury during endoscopic surgery a modified delphi method and single center multidisciplinary working group |
| topic | Complications Endoscopic surgery Rhinology Skull base Endovascular treatment |
| url | https://doi.org/10.1186/s40463-022-00582-w |
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