Endovascular Resuscitation and Trauma Management (eBook)

Bleeding and haemodynamic control

Tal Hörer, Joseph J. DuBose, Todd E. Rasmussen, Joseph M. White (Herausgeber)

eBook Download: PDF

2019 | 1. Auflage
XXIII, 271 Seiten
Springer-Verlag
978-3-030-25341-7 (ISBN)

Infos

This book focuses on endovascular methods for resuscitation and trauma management. Written by highly qualified and clinically active physicians from around the world, it shares information gathered over the past decade, providing a comprehensive database of clinical knowledge for a wide range of practicing clinicians and researchers.

Moreover, it describes basic methods for vascular access, methods for REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta), endo-grafts and embolization methods, as well as other, more advanced methods for endovascular and hybrid resuscitation (CPR REBOA, ECHMO etc.) from the pre-hospital to the post-surgical phase. As the body of literature in this field has grown considerably over the past five years, the book also focuses on summarizing what is known, what the clinical and research evidence is, and 'how to actually use' the various methods. It will help readers understand basic and advanced modern techniques for bleeding control and modern resuscitation, and how to apply them in clinical practice.

 

Tal Hörer, MD PhD, works as a vascular surgeon in Sweden. He is an Associate Professor of Surgery at Örebro University Hospital, where he is responsible for the surgical and vascular residency program. Former military and reserve IDF, his major interests are in clinical research on advanced endovascular and hybrid methods for bleeding control, and in trauma and resuscitation. He is Primary investigator for several studies including the ABOTrauma Registry and works on educations matters and hands-on training. He is a firm believer in REBOA (for correct indications) and EVTM.

Todd E. Rasmussen, MD, FACS is a Colonel USAF MC, Director of the DoD Combat Casualty Care Research Program in Fort Detrick, Maryland, and a Professor of Surgery at the Uniformed Service University. Further, he currently operates as a surgeon at the Veterans Administration Medical Center in Baltimore. He began his surgical training at Wilford Hall Medical Center on Lackland Air Force Base and completed his training in vascular surgery back at Mayo. He was assigned to the National Capital Area two months before 9/11/2001 and after September 11th began caring for the first of the injured returning from Afghanistan at Walter Reed Army Medical Center in Washington. Then he initiated a vascular injury and hemorrhage control research and innovation program. His research efforts have resulted in 130 publications, 25 book chapters, 2 textbooks and 4 patents. Colonel Rasmussen served as Deputy Commander of the Army's Institute of Surgical Research in San Antonio and was subsequently assigned to direct the broader DoD Combat Casualty Care Research Program at Fort Detrick. His awards include the Gold Headed Cane for outstanding clinical and academic practice and the Baron Dominique Jean Larrey Award for Excellence in Military Surgery. In 2015 Colonel Rasmussen was recognized as a Hero in Military Medicine by the Center for Public-Private Partnerships.

 
Joseph J. DuBose, MD FAC FCCM, is a vascular and trauma surgeon with the United States Air Force, presently stationed at Travis Air Force Base in Northern California, USA.   He presently serves as the Secretary of the Aortic Trauma Foundation and as Primary Investigator of the American Association for the Surgery of Trauma's (AAST's) Aortic Occlusion in Trauma and Acute Care Surgery (AORTA) Registry, as well as the PROspective Observational Vascular Injury Treatment (PROOVIT) Registry.  He is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and the University of California - Davis.

Joseph M. White is Associate Program Director, Vascular Surgery Fellowship Assistant and Professor of Surgery at The Department of Surgery at Uniformed Services  University of the Health Sciences and Walter Reed National Military Medical Center of Bethesda

Inhalt

Foreword 6
Foreword 7
Foreword 8
Preface 10
Acknowledgments 12
About the Book 13
Contents 14
Contributors 16
1: The Concept of Endovascular Resuscitation and Trauma Management: Building the EVTM Team 21
1.1 Introduction: Major Hemorrhage and Adjuncts for Its Detection and Control 21
1.2 The Concept of EndoVascular Resuscitation and Trauma Management 23
1.3 Building the EVTM/REBOA Team: Resources Needed for Optimal EVTM 25
1.3.1 Why Waste Time on Imaging? 26
1.4 Optimal Provider Training and Challenges to Skillset Acquisition and Maintenance 27
Expert’s Comments by Ernest E. Moore 28
References 30
2: Principles of Modern Trauma Resuscitation 33
2.1 Background on Hemorrhage and Resuscitation 33
2.2 A History of Resuscitation Strategies 34
2.3 Finding the Appropriate Ratio 36
2.3.1 Component Therapy 38
2.3.1.1 Tranexamic Acid 40
2.3.1.2 Cryoprecipitate and Fibrinogen Concentrates 43
2.3.1.3 Factor Concentrate-Based Resuscitation Strategies 44
2.3.1.4 Factor VIIa 45
2.3.2 Indications and Alternate Endpoints 47
Conclusion 49
Expert’s Comments by Federico Coccolini and Fausto Catena 50
References 50
3: Endovascular Management of Cervical Vascular Trauma 55
3.1 Blunt Cerebrovascular Injuries 55
3.2 Epidemiology and Presentation 56
3.3 Screening and Diagnosis 57
3.4 Medical Treatment 59
3.5 Endovascular Treatment 60
3.6 Penetrating Cervical Vascular Injuries 62
References 66
4: Endovascular Management of Thoracic and Abdominal Trauma 69
4.1 Introduction 69
4.2 Initial Evaluation 70
4.3 Line Placement Considerations 70
4.4 Angiography for Diagnosis and Treatment of Hemorrhage 71
4.5 Embolization Agents 73
4.6 Gelfoam 73
4.7 Particles 73
4.8 Metallic Coils 73
4.9 Amplatzer Vascular Plugs 74
4.10 Liver Endovascular Embolization 74
4.11 Spleen Endovascular Embolization 74
4.12 Kidney Endovascular Embolization 75
4.13 Pelvic Endovascular Embolization 75
4.14 Endovascular Stent Grafts 75
4.15 Axillosubclavian Injuries 76
4.16 Thoracic Endovascular Aortic Repair 77
4.17 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) 81
Conclusion 82
Expert’s Comments by Yoram Kluger 82
References 83
5: Endovascular Surgery for Extremity Trauma 86
5.1 Introduction 86
5.2 Endovascular Damage Control 87
5.3 Lower Extremity Vascular Injuries 87
5.3.1 Common Femoral Artery 88
5.3.2 Profunda Femoris 89
5.3.3 Superficial Femoral Artery 89
5.3.4 Popliteal Artery 89
5.3.5 Infrapopliteal Arteries 90
5.4 Venous Injuries 91
5.5 Traumatic Arteriovenous Fistula and Pseudoaneurysm 91
5.6 Upper Extremity Vascular Injuries 91
5.6.1 Axillo-subclavian Arteries 92
5.6.2 Brachial Artery and Forearm Arteries 94
5.7 Postoperative Care 95
References 95
6: Principles of REBOA 99
6.1 Introduction 99
6.2 History 100
6.3 Indications 101
6.4 Procedure 104
6.4.1 Arterial Access 104
6.4.2 Special Considerations for Access 104
6.4.3 Sheath Placement 105
6.4.4 Balloon Position and Inflation 105
6.4.5 Management While Occluded 106
6.4.6 Balloon Deflation 107
6.4.7 Sheath Removal and Post-resuscitation Care 108
6.5 Current Research 108
Conclusion 110
Expert’s Comments by Catherine Arvieux 110
References 111
7: Partial REBOA 115
7.1 Introduction 115
7.2 Physiology 119
7.2.1 The Effects of Complete Aortic Occlusion 119
7.2.2 The Effects of Partial REBOA 120
7.3 Development of the Technique 121
7.4 Preclinical and Translational Studies of P-REBOA 122
7.5 Clinical Evidence and Case Reports 124
7.6 Feasibility 124
7.7 Future Directions 124
Conclusion 125
References 125
8: REBOA in Traumatic Brain Injuries 128
8.1 Introduction 128
8.2 Traumatic Brain Injury 129
8.2.1 Epidemiology 129
8.2.2 Normal Brain Physiology 130
8.2.3 Pathophysiology After Traumatic Brain Injury 130
8.3 Aortic Occlusion in Patients with Traumatic Brain Injury 131
8.3.1 Complete REBOA, Partial REBOA, and Existing Technology 131
8.4 Future Directions 133
Expert’s Comments by Edoardo Picetti 133
References 134
9: REBOA-Induced Ischemia-Reperfusion Injury 137
9.1 Introduction 137
9.2 Pathophysiology of IRI 138
9.3 Clinical Consequences of IRI 139
9.4 Mitigation Strategies 140
9.4.1 Zone of Placement 141
9.4.2 Balloon Occlusion Time 142
9.4.3 Partial REBOA 142
9.4.4 Pharmacologic Interventions 143
9.4.5 Nitric Oxide Inhibitors 143
9.4.6 Valproic Acid 143
9.4.7 Adenosine 144
9.4.8 Heme Oxygenase 144
9.4.9 Statins 144
9.4.10 Hypothermia 145
9.4.11 Preconditioning and Postconditioning 145
Conclusion 146
References 146
10: REBOA in Nontraumatic Cardiac Arrest 150
10.1 Introduction 150
10.2 Nontraumatic Cardiac Arrest 152
10.2.1 Epidemiology 152
10.2.2 Physiology 152
10.3 Evidence for the Use of Aortic Occlusion in Nontraumatic Cardiac Arrest 153
10.3.1 Preclinical Studies 153
10.3.1.1 Intermittent Occlusion 154
10.3.1.2 Continuous Occlusion 155
10.3.1.3 Selective Aortic Arch Perfusion 156
10.3.2 Clinical Evidence 157
10.3.3 Feasibility of REBOA in Nontraumatic Cardiac Arrest 158
Conclusion: Implementation of REBOA for Nontraumatic Cardiac Arrest 158
References 159
11: Endovascular Balloon Occlusion in Obstetrical Hemorrhage 164
11.1 Introduction 164
11.2 Physiologic Changes of Pregnancy 165
11.3 Uterine Blood Supply 166
11.4 Etiology of Obstetrical Hemorrhage 167
11.5 First Trimester 169
11.5.1 Ectopic Pregnancy 169
11.5.2 Molar Pregnancy 169
11.6 Second and Third Trimesters 170
11.6.1 Placental Abruption 170
11.6.2 Trauma 170
11.6.3 Postpartum Hemorrhage 171
11.6.4 Placenta Accreta Spectrum 171
11.7 Management of Obstetrical Hemorrhage 172
11.8 Massive Transfusion Protocols 173
11.9 Adjunctive Medications 173
11.9.1 Tranexamic Acid 173
11.9.2 Lyophilized Fibrinogen Concentrate 173
11.9.3 Prothrombin Complex Concentrates (PCCs) 174
11.9.4 Activated Recombinant Factor VII 174
11.10 Endovascular Balloon Occlusion 174
11.11 Multidisciplinary Team Management of Endovascular Balloon Occlusion 175
References 177
12: Prehospital and Austere EVTM 181
12.1 Introduction 181
12.2 Prehospital EVTM 182
12.3 Austere EVTM 189
Conclusion 194
Expert’s Comments by Miklosh Bala 194
No One Should Die from Uncontrolled Hemorrhage 194
References 195
13: Endovascular Embolization in Trauma and Bleeding 200
13.1 Background 200
13.2 Categorizing Bleeding Severity 201
13.3 IR: Which Method to Use? 201
13.3.1 Emergency IR (EIR) 201
13.4 Conventional Emergency Interventional Radiology (CEIR): When Conventional Methods Fall Short 203
13.5 Trauma IR (TIR) 204
13.5.1 Overview 204
13.5.2 Preadmission 205
13.5.3 Patient’s Arrival to Trauma Bay 206
13.5.4 Trauma Imaging 206
13.5.4.1 Sub-Seven-Scan: Scan Within 7 Minutes 206
13.5.4.2 Focused Assessment with CT for Trauma (FACT) 206
13.5.5 Patient Selection 207
13.6 Damage Control IR (DCIR) (Table 13.1) 208
13.6.1 Overview 208
13.6.2 Procedure 209
13.6.2.1 In the CT Room 209
13.6.2.2 In the Angiography Suite 210
13.6.2.3 Embolic Agents 210
13.6.3 Key Elements of DCIR 210
13.6.4 Results: Duration of Procedure 211
13.7 Future Trends 212
13.7.1 Hybrid ER Room 212
13.8 Hybrid Trauma Specialist 214
Conclusion 214
References 215
14: Management of the Unstable Patient During EVTM and REBOA 217
14.1 Introduction 217
14.2 Understanding the Physiology of Aortic Occlusion 217
14.3 Communication 218
14.4 Crew Resource Management 219
14.5 REBOA Before or After Anesthesia? 219
14.6 Nonarterial Circulatory Access 220
14.7 Induction of Anesthesia 220
14.8 Maintenance of Anesthesia 221
14.9 Analgesia 221
14.10 Hemostatic Resuscitation 222
14.11 Afterload Reduction 222
14.12 Monitoring 222
14.13 Electrolyte Management 223
14.14 Balloon Deflation 223
Conclusion 224
Experts’ Comments by Luca Ansaloni and Federico Coccolini 224
References 225
15: Extracorporeal Membrane Oxygenation in the Unstable Trauma Patient 226
15.1 VV and VA ECMO Circuit Overview 226
15.2 VV ECMO 226
15.3 VV ECMO Circuit Management 229
15.3.1 VV ECMO Cannulation Strategies 229
15.3.2 Monitoring Targets 230
15.4 VV ECMO Patient Management 230
15.4.1 Anticoagulation Range 230
15.4.2 Ventilator Management 231
15.4.3 Sedation Strategies 231
15.4.4 Peri-procedural Management 231
15.4.5 Tracheostomy Timing and Technique 232
15.4.6 Early Mobilization and Physical Therapy 232
15.5 VA ECMO 232
Conclusions 233
Experts’ Comments by Emiliano Gamberini and Alessandro Circelli 234
References 235
16: Postoperative Critical Care Management Considerations 239
16.1 Introduction 239
16.2 Physiological Alterations and Organ Complications After REBOA 240
16.3 Important Information for the Intensivist from the Trauma Team 241
16.4 Access-Related Complications 241
16.5 Cardiovascular Monitoring and Treatment 241
16.6 Fluid Resuscitation 242
16.7 Cardiovascular and Circulatory Support 242
16.8 Extracorporeal Membrane Oxygenation 243
16.9 Coagulation 243
16.10 Gastrointestinal Tract and Nutrition 245
16.11 Renal Function 246
Conclusions 246
Expert’s Comments by Andrew Kirkpatrick 246
References 247
17: Complications of Endovascular and Hybrid Surgery 253
17.1 Access Site Complications 253
17.1.1 Hematoma 253
17.1.2 Pseudoaneurysm 254
17.1.3 Acquired Arteriovenous Fistula 254
17.2 Intervention Complications 255
17.2.1 Dissection 256
17.2.2 Thrombosis/Embolization 256
17.2.3 Rupture 257
17.3 Post-procedure Complications 258
17.3.1 Infection 258
17.3.2 Contrast-Induced Nephropathy 258
17.3.3 Contrast Media Allergy 259
Conclusion 259
References 259
18: Endovascular Resuscitation and Trauma Management: Education and Simulation 262
18.1 The Necessity of Education and Simulation 262
18.2 The Bridge and Synergies Between Open Surgery and the Endovascular Approach 263
18.3 EVTM Practitioners: Who Are the Educational Targets? 263
18.4 Nontechnical Skills in EVTM Education 264
18.5 Technical Skills in EVTM: Achievable Goals of EVTM Education and Simulation 264
18.6 What Resources Can We Use for Away-from-the-Job Simulation in EVTM Education? 266
18.6.1 Simulators 266
18.6.2 Porcine Models 266
18.6.3 Cadaver 268
18.6.4 Cath-Lab Training 269
18.7 Summary 270
References 270

Produkt-Details

• Erscheint lt. Verlag: 10.12.2019
• Reihe/Serie: Hot Topics in Acute Care Surgery and Trauma
• Zusatzinfo: XXIII, 262 p. 40 illus., 26 illus. in color.
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie
• Themenwelt: Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren ► Radiologie
• Themenwelt: Medizin / Pharmazie ► Pflege
• Schlagworte: abdominal surgery • Aortic Balloon occlusion • Bleeding • Endovascular bleeding management • Endovascular resuscitation • haemorrhage • REBOA • Trauma • trauma surgery
• ISBN-10: 3-030-25341-4 / 3030253414
• ISBN-13: 978-3-030-25341-7 / 9783030253417