Resuscitative endovascular balloon occlusion of the aorta performed by emergency physicians for traumatic hemorrhagic shock: a case series from Japanese emergency rooms.

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA), which has been increasingly used for the management of hemorrhagic shock, is a less invasive strategy for the management of patients with very severe hemorrhage. However, its effectiveness remains controversial. METHODS: This retrospective case series included trauma patients who underwent REBOA for hemorrhagic shock due to trauma in four Japanese tertiary care emergency centers from January 2013 to March 2017. Patients in cardiac arrest at the time of REBOA and those who underwent REBOA for nontraumatic causes during the study period were excluded. RESULTS: A total of 24 patients underwent REBOA during the study period. The median age was 52 years (interquartile range (IQR) 36.5-62.5), 17 (70.8%) of the patients were male, and 23 (95.8%) had blunt trauma. The 24-h survival was 50% (n = 12), and the in-hospital survival rate was 41.7% (10/24). In all cases, REBOA was performed in emergency rooms by emergency physicians without fluoroscopic guidance. Complications of REBOA were mesenteric ischemia (n = 1, 4.2%), ischemia of the lower extremities (n = 1, 4.2%), and placement of REBOA in thoracic aortic injury (n = 3, 12.5%). CONCLUSIONS: REBOA can be an effective and feasible tool for controlling massive hemorrhage due to trauma. However, caution should be exercised regarding complications including placement of REBOA in aortic injury and limb ischemia in cases where REBOA is performed in an emergency department setting with minimal or no support from trauma surgeons.

A lethal case of mamushi (Gloydius blomhoffii) bite: severe bowel symptoms as a lethal sign.

Case: We report a lethal case of a mamushi (Gloydius blomhoffii) bite. An 84-year-old woman was bitten by a mamushi snake on her right elbow. She was initially treated at another hospital, however, because the swelling expanded and her renal function worsened, she was transferred to our hospital. Compartment syndrome, thrombocytopenia, respiratory arrest, and elevated creatinine kinase and lactose dehydrogenase levels were seen; renal failure progressed, and ileus and peritonitis due to colon perforation occurred. Outcome: The patient died 35 days after the bite. An autopsy revealed widespread necrosis of the ileum, colon, and liver. Conclusion: This report supplies useful clinical information on the treatment of severe mamushi bite cases, and severe abdominal symptoms, such as ileus and melena, may be a lethal sign.