Contemporary Utilization and Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Noncompressible Torso Hemorrhage in Korea: A Retrospective Multi-Center Study

Purpose@#This study aimed to evaluate the utilization and outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in managing noncompressible torso hemorrhage (NCTH) among trauma patients in Korea. The evolution of REBOA and its impact on patient survival was investigated as well as predictors of mortality. @*Methods@#This retrospective study included 234 post-REBOA patients from 5 leading regional trauma centers across Korea between 2016 and 2021. Primary outcomes were in-hospital mortality, and secondary outcomes were various clinical parameters regarding REBOA, overall treatment flow, and complications. For comparative analyses, patients were dichotomized into in-hospital non-survivors or survivors. Then, generalized additive and linear regression models were used to evaluate the trend of in-hospital mortality. @*Results@#The overall in-hospital mortality was 65.4%. The survivors had a higher proportion of responders following REBOA (87.7% vs 62.7%, p < 0.001). Key variables influencing outcomes included total occlusion time, red blood cell transfusion volume within the first 24 hours, revised trauma score, and systolic blood pressure gap. These factors significantly correlated with mortality rates in multivariate logistic regression. @*Conclusion@#Over 6 years, survival rates for NCTH patients undergoing REBOA in Korea have shown improvement. Despite diverse REBOA protocols across institutions, the results underscore the need for continued research, standardized practices, and national quality control measures to further optimize patient outcome and establish more effective treatment protocols for NCTH.

The efficacy of the “no zone” approach for the assessment of traumatic neck injury: a case-control study

Purpose@#Recently, several studies have demonstrated symptom-based, non-zonal algorithms for approaching penetrating neck injuries. The purpose of this study was to confirm the effectiveness of the “no zone” approach in traumatic neck injuries. @*Methods@#Medical charts of patients with traumatic neck injuries who presented at the Regional Trauma Center in South Korea between January 2014 and December 2018 were retrospectively reviewed. Negative final neck findings (FNFs) were compared with positive FNFs (which include major vascular, aerodigestive, nerve, endocrine gland, cartilage, or hyoid bone injuries) using multivariate logistic regression analysis including values of the “zone” and/or no zone approach. @*Results@#Out of 168 trauma patients, 70 patients with a minor injury and 7 patients under the age of 18 years were excluded. Of the remaining 91 patients, 74 (81.3%) had penetrating neck injuries and 17 (18.7%) had blunt neck injuries. Initial diagnosis most frequently revealed external wounds in zone II (84.6%). Twenty (22.0%) and 36 (39.5%) patients had hard and soft signs, respectively, using the no zone approach. Further, there was a significant difference between the negative and positive FNFs in patients with hard signs (11.6% vs. 54.5%; P < 0.01, respectively). According to the multivariate logistic regression analysis, the hard signs were associated with an odds ratio (OR) for FNFs (OR, 18.92; 95% confidence interval, 3.55–157.60). @*Conclusion@#Traumatic neck injuries classified as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.

Experiences of the Emergency Department at the Pyeongchang Polyclinic During the 2018 PyeongChang Winter Olympic Games

PURPOSE: The 2018 PyeongChang Winter Olympic Games involved 2925 elite athletes, and providing proper health care services for these elite athletes was a critical priority. We established an emergency department (ED) in the Pyeongchang Mountain Polyclinic during the Olympics, which served staff and athletes from many countries. This experience, as well as a description of illnesses and injuries encountered during the games, may provide useful information for planning medical care at similar events in the future. MATERIALS AND METHODS: The polyclinic ED operated from January 25 to February 27, 2018. All cases were enrolled in this study, and their data were analyzed by date and category. In addition, the number of injuries by body part, number of illnesses by organ system, and illness symptoms and causes were analyzed. RESULTS: In total, 288 patients were encountered in the ED. These included 113 injuries and 175 illnesses. We consulted with 153 staff members and 75 athletes, and reported that the fingers were the most commonly injured body part, followed by the knee. The respiratory system was the most commonly involved organ system, and the most common cause of illness was infection. Thirty-eight influenza tests were performed, among which the results of seven were positive. We performed 17 norovirus tests, among which the results of four were positive. CONCLUSION: Our analysis of our ED experience will aid arrangements for medical services in future Winter Games. Additionally, given our new experience, we will now be able to provide better medical services for future winter sports events.

Preperitoneal Pelvic Packing Prior to Pelvic Angiography in Patients with Hemodynamic Instability due to Severe Pelvic Fracture: Two Cases

The mortality of patients with hemodynamic instability due to severe pelvic fracture is high despite multidisciplinary management. Current management algorithms for these patients emphasize pelvic angioembolization (AE) for hemorrhage control. However, a surgical procedure is often needed because AE is time-consuming and approximately only 15% of patients have arterial bleeding. Most hemorrhages from severe pelvic fracture originate from venous or bone injury. Current research demonstrates the effectiveness of preperitoneal pelvic packing (PPP) in hemorrhage control. However, there are no reports of its use in Korea. Accordingly, we present our early experiences of PPP for control of hemorrhage due to severe pelvic fracture in a trauma center in Korea.

Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access / 대한구급학회지

BACKGROUND: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. METHODS: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. RESULTS: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). CONCLUSIONS: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.

Erratum: Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access / 대한구급학회지

We found an error in this article. The author's affiliation.

Erratum: Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access / 대한중환자의학회지

We found an error in this article. The author's affiliation.

Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access / 대한중환자의학회지

BACKGROUND: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. METHODS: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. RESULTS: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). CONCLUSIONS: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.