RESUMEN
This is a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians regarding the clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA. This statement addresses the system of care needed to manage trauma patients requiring the use of REBOA, in light of the current evidence available in this patient population. This statement was developed by an expert panel following a comprehensive review of the literature with representation from all sponsoring organizations and the US Military. This is an update to the previous statement published in 2018. It has been formally endorsed by the four sponsoring organizations.
RESUMEN
Resuscitative endovascular occlusion of the aorta (REBOA) is a rapidly evolving technology which requires careful system-wide multidisciplinary implementation for optimal success. These guidelines developed by experienced REBOA practitioners provide a framework for a key practitioner to use in the development of a REBOA program in their institution. They detail the importance of involving doctors, nurses, and staff across departments and disciplines in the application of this technique.
Asunto(s)
Oclusión con Balón/métodos , Prestación Integrada de Atención de Salud/organización & administración , Procedimientos Endovasculares/métodos , Resucitación/métodos , Choque Hemorrágico/cirugía , Aorta , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
Damage control surgery (DCS) began as an adjunct approach to hemorrhage control, seeking to facilitate the body's innate clotting ability when direct repair or ligation was impossible, but it has since become a valuable instrument for a broader collection of critically ill surgical patients in whom metabolic dysfunction is the more immediate threat to life than imminent exsanguination. Modern damage control is a strategy that combines the principles of DCS with those of damage control resuscitation. When used correctly, damage control may improve survival in previously unsalvageable patients; when used incorrectly, it can subject patients to imprudent risk and contribute to morbidity. This review discusses the evolution of damage control in both concept and practice, summarizing available literature and experience to guide patient selection, medical decision-making, and strategy implementation throughout the preoperative, intraoperative, and early postoperative periods.
RESUMEN
Trauma is the leading cause of death among patients 46 years or younger, and having a system in place for the care of the injured is of paramount importance to the health of a community. The growth and development of civilian trauma systems has not been an easy process. The concept of regionalized health care that the trauma system models has been emulated by other specialized and time-sensitive areas of medicine, notably stroke and acute cardiac events. Continued process improvement, public education, support and involvement, a sound infrastructure, and integrated technology should remain our focus.
Asunto(s)
Centros Traumatológicos , Heridas y Lesiones/terapia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Programas Médicos Regionales/historia , Centros Traumatológicos/historia , Centros Traumatológicos/organización & administración , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos , Heridas y Lesiones/historiaRESUMEN
We present our experience of a unique opportunity to survey coronary artery bypass graft (CABG) patency following the administration of recombinant factor VIIa in the early postoperative period. A review of the published literature on use of this medication in cardiothoracic surgery, specifically CABG, is included.