Efficacy of direct-to-operating room trauma resuscitation: a systematic review.

BACKGROUND: Hemorrhage control is a time-critical task, and recent studies have demonstrated that a shorter time to definitive care is positively associated with patient survival and functional outcomes. The concept of direct transport to the operating room was proposed in the 1960s to reduce treatment time. Some trauma centers have developed protocols for direct-to-operating room resuscitation (DOR) programs. Moreover, few studies have reported the clinical outcomes of DOR in patients with trauma; however, their clinical effect in improving the efficiency and quality of care remains unclear. In this systematic review, we aimed to consolidate all published studies reporting the effect of DOR on severe trauma and evaluate its utility. METHODS: The PubMed, EMBASE, and Cochrane databases were searched from inception to April 2023, to identify all articles published in English that reported the effect of direct-to-operating room trauma resuscitation for severe trauma. The articles were reviewed as references of interest. RESULTS: We reviewed six studies reporting the clinical effect of operating room trauma resuscitation. A total of 3232 patients were identified. Five studies compared the actual mortality with the predicted mortality using the trauma score and injury severity score, while one study compared mortality using propensity matching. Four studies reported that the actual survival rate for overall injuries was better than the predicted survival rate, whereas two studies reported no difference. Some studies performed subgroup analyses. Two studies showed that the survival rate for penetrating injuries was better than the predicted survival rate, and one showed that the survival rate for blunt injuries was better than the predicted survival rate. Five studies reported the time to surgical intervention, which was within 30 min. Two studies time-compared surgical intervention, which was shorter in patients who underwent DOR. CONCLUSION: Implementing DOR is likely to have a beneficial effect on mortality and can facilitate rapid intervention in patients with severe shock. Future studies, possibly clinical trials, are needed to ensure a proper comparison of the efficiency.

Risk Factors and Management of Blunt Inferior Vena Cava Injury: A Retrospective Study.

BACKGROUND: Traumatic inferior vena cava (IVC) injuries are uncommon, but the mortality rate remains high at 38-70%. To date, most studies on traumatic IVC injuries have evaluated blunt rather than penetrating injuries. We aimed to identify the clinical features and risk factors that affect the prognosis of patients with blunt IVC injuries to improve treatment strategies for these patients. METHODS: We retrospectively analyzed patients diagnosed with blunt IVC injury over 8 years at a single trauma center. Clinical and biochemical parameters; transfusion, surgical, and resuscitation methods; associated injuries; intensive care unit stay; and complications data were compared between survival and death groups to identify clinical features and risk factors of blunt IVC injury-related mortality. RESULTS: Twenty-eight patients with blunt IVC injury were included during the study periods. Twenty-five (89%) patients underwent surgical treatment, and the mortality was 54%. The mortality rate according to the IVC injury location was the lowest for supra-hepatic IVC injury (25%, n = 2/8), whereas it was the highest for retrohepatic IVC injury (80%, n = 4/5). In the logistic regression analysis, Glasgow Coma Scale (GCS) (odds ratio [OR] = 0.566, 95% confidence interval [CI] [0.322-0.993], p = 0.047) and red blood cell (RBC) transfusion for 24 h (OR = 1.132, 95% CI [0.996-1.287], p = 0.058) were independent predictors for mortality. CONCLUSIONS: Low GCS score and high-volume packed RBC transfusion requirements for 24 h were significant predictors of mortality in patients with blunt IVC injuries. Unlike IVC injuries caused by penetrating trauma, supra-hepatic IVC injuries caused by blunt trauma have a good prognosis.

Isocaloric nutritional support reduces ventilator duration time in major trauma patients.

AIMS: Major trauma patients need adequate nutrition for recovery. This study aimed to evaluate the adequacy of nutritional supply and the correlation between nutritional supply and clinical outcome. METHODS: A single-centre retrospective observational study was undertaken, describing the amounts of energy and proteins provided to 320 critically ill trauma patients during the first 10 days after admission. The data were collected from the electronic medical records of patients admitted to the trauma intensive care unit during the study period and descriptive statistical analyses were performed with the SPSS software. RESULTS: The mean proportion of supplied energy to recommended energy during the first 10 days after admission was 57.5%, and the mean percentage of supplied protein to recommended protein intake was 51.3%. The patients were divided into those who received ≥70% (isocaloric nutrition group) and those who received <70% (hypocaloric nutrition group) of their estimated requirements. Both the duration of ventilator use (12.7 ± 10.5 vs. 16.0 ± 15.8 days, respectively, p = 0.009) and duration of parenteral nutrition (1.1 ± 1.4 vs. 2.0 ± 2.0 days, respectively, p = 0.001) were shorter in the isocaloric nutrition group (n = 83) than in the hypocaloric nutrition group (n = 237). CONCLUSION: Total energy and the amount of protein supplied were insufficient compared to the recommended amount. The duration of ventilator use was shorter in the isocaloric nutrition group than in the hypocaloric nutrition group. The association between shortened ventilator use and isocaloric nutrition requires further investigation as a potential intervention to reduce the risk of complications such as ventilator-related pneumonia.

Successful treatment of a blunt retrohepatic vena cava injury using an atriocaval shunt without sternotomy or thoracotomy: a case report.

Retrohepatic vena cava (RHIVC) injury is often fatal and can be very difficult to manage. Total hepatic vascular isolation, a shunt, or bypass surgery is required for the surgical treatment of RHIVC injury in hemodynamically unstable patients; however, these are not easy procedures. Here, we present a case of RHIVC injury that was successfully treated by atriocaval shunt placement via a transdiaphragmatic incision without sternotomy or thoracotomy. In addition, we review the resuscitation and surgical procedures used for total hepatic vascular isolation in patients with RHIVC injury.

Management strategy for open pelvic fractures: A 11-year single-centre, retrospective observational study.

INTRODUCTION: Open pelvic fractures are commonly associated with life-threatening, uncontrollable haemorrhages. Although management methods for pelvic injury-associated haemorrhage have been established, the early mortality rate associated with open pelvic fractures remains high. This study aimed to identify predictors of mortality and effective treatment methods for open pelvic fractures. METHODS: We defined open pelvic fractures as pelvic fractures with an open wound directly connected to the adjacent soft tissue, genitals, perineum, or anorectal structures, resulting in soft tissue injuries. This study was performed on trauma patients (age ≥15 years) injured by a blunt mechanism between 2011 and 2021 at a single trauma centre. We collected and analysed the data on the Injury Severity Score (ISS), the Revised Trauma Score (RTS), the Trauma and Injury Severity Score (TRISS), length of hospital stay, length of intensive care unit stay, transfusion, preperitoneal pelvic packing (PPP), resuscitative endovascular balloon occlusion of the aorta (REBOA), therapeutic angio-embolisation, laparotomy, faecal diversion, and mortality. RESULTS: Forty-seven patients with blunt open pelvic fractures were included. The median age was 45 years (interquartile range, 27-57 years) and median ISS was 34 (24-43). The most frequently performed treatment methods were laparotomy (53%) and pelvic binder (53%), followed by faecal diversion (40%) and PPP (38%). PPP was the only method performed at a higher rate in the survival group for haemorrhagic control (41% vs. 30%). Haemorrhagic mortality was present in one case that received PPP. The overall mortality was 21%. In the univariate logistic regression analysis, initial systolic blood pressure (SBP), TRISS, RTS, packed red blood cell transfusion for the first 24 h, and base excess showed statistical significance (p<0.05). In the multivariate logistic regression model, initial SBP was identified as an independent risk factor for mortality (odds ratio, 0.943; 95% confidence interval, 0.907-0.980; p = 0.003). CONCLUSION: A low initial SPB may be an independent predictor of mortality in patients with open pelvic fractures. Our findings suggest that PPP might be a feasible method to decrease haemorrhagic mortality from open pelvic fractures, especially for haemodynamically unstable patients with low initial SBP. Further studies are required to validate these clinical findings.

Nutritional assessment formulae for nutritional requirement determination in severe trauma.

BACKGROUND AND OBJECTIVES: It is often difficult to assess the nutritional requirements of severely injured patients. In this study, we aimed to determine whether various nutritional assessment formulas are accurate at assessing the nutritional requirements of trauma patients. METHODS AND STUDY DESIGN: We recruited trauma patients who were admitted to a trauma centre in 2018 and were identified as being at high risk for malnutrition. Energy expenditure was calculated using commonly used prediction equations, and the results were compared to resting energy expenditures measured using indirect calorimetry. RESULTS: Sixty-nine patients (78.9% men; mean age, 53.6 years) collectively underwent 95 indirect calorimetry assessments. The average resting energy expenditure was 1761.8±483.8 kcal/day, and the average respiratory quotient was 0.8±0.2. The correlations between the measured resting energy expenditures and nutritional requirements estimated by each formula were significant but weak (i.e., r-values <0.8). The Penn State formula had the highest r-value (0.742; 95% confidence interval [CI], 0.6359-0.8210), followed by the Faisy formula (0.730; 95% CI, 0.620-0.812). CONCLUSIONS: The formulapredicted nutritional requirements did not adequately correlate with the resting energy expenditures measured by indirect calorimetry. Therefore, we recommend using indirect calorimetry to assess the nutritional requirements of severely injured patients.

Gate-voltage-induced reversible electrical phase transitions in Mo0.67W0.33Se2 devices.

Tunable electrical phase transitions based on the structural and quantum-state phase transitions in two-dimensional transition-metal dichalcogenides have attracted attention in both semiconducting electronics and quantum electronics applications. Here, we report gate-voltage-induced reversible electrical phase transitions in Mo0.67W0.33Se2 (MoWSe) field-effect transistors prepared on SiO2/Si substrates. In gate-induced depletion regions of the 2H phase, an electrical current resumes flow at 150 K < T < 200 K with decreasing T irrespective of the layer number (n) for MoWSe when n < 20. The newly appearing electron-doped-type conducting channel again enters the 2H-phase region when the back-gate voltage increases, accompanied by the negative differential transconductance for four-layer and monolayer devices or by a deflection point in the transfer curves for a multilayer device. The thermal activation energies of the new conducting and 2H-phase branches differ by one order of magnitude at the same gate voltage for both the four-layer and monolayer cases, indicating that the electrical band at the Fermi level was modified. The hysteresis measurements for the gate voltage were performed with a five-layer device, which confirms the reversible electrical transition behavior. The possible origins of the nucleated conducting phase in the depletion region of the 2H phase of MoWSe are discussed.

Improvement of mortality in severe liver injury after trauma center implementation: a propensity score matched study.

PURPOSE: To evaluate changes in the management and outcome of severe liver injury after trauma center implementation. METHODS: Trauma patients with severe liver injury (organ injury scale score ≥ 4) treated between January 2011 and December 2020 were retrospectively reviewed. A trauma center was built in 2016 at our institution, and patients were dichotomized into two groups: before trauma center (BTC) and after trauma center (ATC) group. Treatment methods and outcomes were compared between the groups with 1:1 propensity score matching. RESULTS: We included 50 patients in the BTC group and 104 patients in the ATC group. Patients in the ATC group had frequent utilization of angiography (16% vs 47.1%, p < 0.001), faster transfusion [84 (37-152) min vs 17 (10-79) min, p < 0.001], and less fluid administration within 24 h [8.3 (5.7-13.7) L vs 5.7 (3.1-10.1) L, p = 0.002]. However, mortality rate was not significantly different between the groups (26.0% vs 20.2%, p = 0.416). 1:1 propensity score matching was performed using the variables of age, injury severity score, systolic blood pressure, Glasgow Coma Scale, and initial base excess level. After matching, the mortality rate (26.0% vs 10.0%, p = 0.037) and ventilator application (74.0% vs 54.0%, p = 0.037) significantly improved. CONCLUSION: Severe liver injury management improved after trauma center implementation.

Maternal Outcomes and Clinical Characteristics of COVID-19 in Korean Pregnant Women during the Early Period of the Pandemic.

The present study aimed to compare the clinical characteristics and outcomes between pregnant women and non-pregnant women of childbearing age (20-49 years old) diagnosed with coronavirus disease 2019 (COVID-19) during the initial stage of the COVID-19 pandemic in the Republic of Korea. This nationwide observational study included the information of COVID-19 patients collected by the Korea Disease Control and Prevention Agency from January 2020 to April 2021. Among 5,647 COVID-19 patients, 2,444 (43.3%) were women of childbearing age and 19 were pregnant. None of the pregnant women died. However, 4 deaths occurred among non-pregnant women aged 20-49 years. None of the 19 pregnant women with COVID-19 were admitted to the intensive care unit: they were admitted to the general ward, and none of them required supplemental oxygen. In conclusion, none of the pregnant women with COVID-19 experienced severe infection or death, unlike non-pregnant women of childbearing age.

Indium-contacted van der Waals gap tunneling spectroscopy for van der Waals layered materials.

The electrical phase transition in van der Waals (vdW) layered materials such as transition-metal dichalcogenides and Bi2Sr2CaCu2O8+x (Bi-2212) high-temperature superconductor has been explored using various techniques, including scanning tunneling and photoemission spectroscopies, and measurements of electrical resistance as a function of temperature. In this study, we develop one useful method to elucidate the electrical phases in vdW layered materials: indium (In)-contacted vdW tunneling spectroscopy for 1T-TaS2, Bi-2212 and 2H-MoS2. We utilized the vdW gap formed at an In/vdW material interface as a tunnel barrier for tunneling spectroscopy. For strongly correlated electron systems such as 1T-TaS2 and Bi-2212, pronounced gap features corresponding to the Mott and superconducting gaps were respectively observed at T = 4 K. We observed a gate dependence of the amplitude of the superconducting gap, which has potential applications in a gate-tunable superconducting device with a SiO2/Si substrate. For In/10 nm-thick 2H-MoS2 devices, differential conductance shoulders at bias voltages of approximately ± 0.45 V were observed, which were attributed to the semiconducting gap. These results show that In-contacted vdW gap tunneling spectroscopy in a fashion of field-effect transistor provides feasible and reliable ways to investigate electronic structures of vdW materials.

A Benzothiazole-Based Fluorescence Turn-on Sensor for Copper(II).

A new benzothiazole-based chemosensor BTN (1-((Z)-(((E)-3-methylbenzo[d]thiazol-2(3H)-ylidene)hydrazono)methyl)naphthalen-2-ol) was synthesized for the detection of Cu2+. BTN could detect Cu2+ with "off-on" fluorescent response from colorless to yellow irrespective of presence of other cations. Limit of detection for Cu2+ was determined to be 3.3 µM. Binding ratio of BTN and Cu2+ turned out to be a 1:1 with the analysis of Job plot and ESI-MS. Sensing feature of Cu2+ by BTN was explained with theoretical calculations, which might be owing to internal charge transfer and chelation-enhanced fluorescence processes.

Tunneling Spectroscopy for Electronic Bands in Multi-Walled Carbon Nanotubes with Van Der Waals Gap.

Various intriguing quantum transport measurements for carbon nanotubes (CNTs) based on their unique electronic band structures have been performed adopting a field-effect transistor (FET), where the contact resistance represents the interaction between the one-dimensional and three-dimensional systems. Recently, van der Waals (vdW) gap tunneling spectroscopy for single-walled CNTs with indium-metal contacts was performed adopting an FET device, providing the direct assignment of the subband location in terms of the current-voltage characteristic. Here, we extend the vdW gap tunneling spectroscopy to multi-walled CNTs, which provides transport spectroscopy in a tunneling regime of ~1 eV, directly reflecting the electronic density of states. This new quantum transport regime may allow the development of novel quantum devices by selective electron (or hole) injection to specific subbands.

Gate-tunable quantum dot formation between localized-resonant states in a few-layer MoS2.

We demonstrate a gate-tunable quantum dot (QD) located between two potential barriers defined in a few-layer MoS2. Although both local gates used to tune the potential barriers have disorder-induced QDs, we observe diagonal current stripes in current resonant islands formed by the alignment of the Fermi levels of the electrodes and the energy levels of the disorder-induced QDs, as evidence of the gate-tunable QD. We demonstrate that the charging energy of the designed QD can be tuned in the range of 2-6 meV by changing the local-gate voltages in ∼1 V.

Early re-laparotomy for patients with high-grade liver injury after damage-control surgery and perihepatic packing.

PURPOSE: The likelihood of re-bleeding after damage-control surgery (DCS) and perihepatic packing for high-grade liver injuries is a major concern. Thus, although early re-laparotomy tends to be recommended, we conducted this study to evaluate the feasibility of performing definite laparotomy within ≤ 48 h in this clinical population. METHODS: The subjects of this retrospective study were 65 patients (n = 24, ≤ 48-h group; n = 41, > 48-h group) who underwent DCS and perihepatic packing. The primary outcome was the rate of repacking for bleeding during re-laparotomy and the secondary outcomes were mortality and length of stay in the intensive care unit (ICU). RESULTS: The ≤ 48-h group had a higher rate of angioembolization and transfusion of red blood cells (RBCs), fresh frozen plasma, and platelets, but the rates of repacking and mortality were not significantly different between the groups. However, the incidence of pneumonia and ventilation support requirement were significantly lower in the ≤ 48-h group than in the > 48-h group. CONCLUSION: The re-laparotomy performed within ≤ 48 h after DCS and perihepatic packing is feasible for patients with high grade liver injury, using angioembolization and aggressive transfusion, as required. Early re-laparotomy reduces the need for prolonged ventilator support and the incidence of ventilator-associated pneumonia.

Analysis of the need for surgery for different anatomical locations of splenic injury and radiologic intervention.

The splenic surface can be anatomically divided into the visceral surface connected to major blood vessels and the diaphragmatic surface attached to the diaphragm. This study aimed to investigate differences in future treatment and outcomes according to the anatomical location of splenic injuries following abdominal trauma. Patients who were treated at a single trauma center between January 2011 and April 2018 were included. The presence of lacerations or hematoma on the visceral surface was evaluated via computed tomography. Differences in the location of splenic surgery between a group that underwent surgical or radiologic intervention and a group that received conservative care only were analyzed. Of 355 patients with splenic injury analyzed, the total mortality rate was 15.2%. A total of 167 patients underwent surgery and angiographic embolization, and 168 received conservative care only. Splenic injuries involved the visceral surface in 127 and 105 patients in the respective groups. Significant differences in the incidence of splenic injuries involving the visceral surface were found between the two groups in the univariate and logistic regression analyses. The likelihood of needing surgery and treatments such as embolization was higher for cases of splenic injury involving the visceral surface than for splenic injuries that did not involve the visceral surface. Through additional research, it may become possible to analyze the location of a splenic injury to determine an effective and safe method of treatment and accurately predict a prognosis. Clin. Anat. 33:516-521, 2020. © 2019 Wiley Periodicals, Inc.

Sign of Life is Associated with Return of Spontaneous Circulation After Resuscitative Thoracotomy: Single Trauma Center Experience of Republic of Korea.

BACKGROUND: Resuscitative thoracotomy (RT) can be a lifesaving treatment, but it has not yet been performed in Korea. In this study, we review our experience of RT after a regional trauma center was constructed. METHODS: This is a retrospective study of RT conducted at a single Korean trauma center from May 2014 to March 2018. The primary outcome was survival, and the secondary outcome was return of spontaneous circulation (ROSC). The clinical characteristics of the patients were compared between the ROSC and non-ROSC groups. Survivors were also reviewed. RESULTS: A total of 62 patients were reviewed, and 60 patients had experienced blunt injury. Thirty-nine patients had ROSC. The ROSC group had short cardiopulmonary resuscitation (CPR) time (6 [2-10] min vs 11 [8-12] min, p < 0.001), the presence of sign of life at the trauma bay [32 (86.5%) vs 7 (28.0%), p < 0.001], and a low Injury Severity Score [26 (25-39) vs 37 (30-75), p = 0.038] compared to the non-ROSC group. On multivariate analysis, only the presence of sign of life was significantly associated with ROSC [11.297 (1.496-85.309) OR (95% CI), p = 0.019]. The 24-h survival rate was 8.1%, and the successful discharge rate was 4.8%. CONCLUSION: The outcome of RT in a Korean trauma center was favorable. ROSC after RT was strongly associated with the presence of sign of life, and RT may be performed in the presence of sign of life regardless of prehospital CPR time.

Timing and Associated Factors for Sepsis-3 in Severe Trauma Patients: A 3-Year Single Trauma Center Experience.

BACKGROUND: We hypothesized that the recent change of sepsis definition by sepsis-3 would facilitate the measurement of timing of sepsis for trauma patients presenting with initial systemic inflammatory response syndrome. Moreover, we investigated factors associated with sepsis according to the sepsis-3 definition. METHODS: Trauma patients in a single level I trauma center were retrospectively reviewed from January 2014 to December 2016. Exclusion criteria were younger than 18 years, Injury Severity Score (ISS) <15, length of stay <8 days, transferred from other hospitals, uncertain trauma history, and incomplete medical records. A binary logistic regression test was used to identify the risk factors for sepsis-3. RESULTS: A total of 3,869 patients were considered and, after a process of exclusion, 422 patients were reviewed. Fifty patients (11.85%) were diagnosed with sepsis. The sepsis group presented with higher mortality (14 [28.0%] vs. 17 [4.6%], P<0.001) and longer intensive care unit stay (23 days [range, 11 to 35 days] vs. 3 days [range, 1 to 9 days], P<0.001). Multivariate analysis demonstrated that, in men, high lactate level and red blood cell transfusion within 24 hours were risk factors for sepsis. The median timing of sepsis-3 was at 8 hospital days and 4 postoperative days. The most common focus was the respiratory system. CONCLUSIONS: Sepsis defined by sepsis-3 remains a critical issue in severe trauma patients. Male patients with higher ISS, lactate level, and red blood cell transfusion should be cared for with caution. Reassessment of sepsis should be considered at day 8 of hospital stay or day 4 postoperatively.

Efficacy of Uncross-Matched Type O Packed Red Blood Cell Transfusion to Traumatic Shock Patients: a Propensity Score Match Study.

A new blood bank system was established in our trauma bay, which allowed immediate utilization of uncross-matched type O packed red blood cells (UORBCs). We investigated the efficacy of UORBC compared to that of the ABO type-specific packed red blood cells (ABO RBCs) from before the bank was installed. From March 2016 to February 2017, data from trauma patients who received UORBCs in the trauma bay were compared with those of trauma patients who received ABO RBCs from January 2013 to December 2015. Propensity matching was used to overcome retrospective bias. The primary outcome was 24-hour mortality, while the secondary outcomes were in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Data from 252 patients were reviewed and UORBCs were administered to 64 patients. The time to transfusion from emergency room admission was shorter in the UORBC group (11 [7-16] minutes vs. 44 [29-72] minutes, P < 0.001). After propensity matching, 47 patients were included in each group. The 24-hour mortality (4 [8.5%] vs. 9 [13.8%], P = 0.135), in-hospital mortality (14 [29.8%] vs. 18 [38.3%], P = 0.384), and ICU LOS (9 [4-19] days vs. 5 [0-19] days, P = 0.155) did not differ significantly between groups. The utilization of UORBCs resulted in a faster transfusion but did not significantly improve the clinical outcomes in traumatic shock patients in this study. However, the tendency for lower mortality in the UORBC group suggested the need for a large study.

The use of an engineered single chain variable fragment in a localized surface plasmon resonance method for analysis of the C-reactive protein.

A gold nanorod (GNR) based LSPR sensor has been developed for label-free detection of C-reactive protein (CRP). The sensor utilizes a single chain variable fragment (scFv) as a receptor to bind CRP. The results of this effort show that CRP in human serum can be quantitatively detected at lower than 1 ng mL(-1).