Hagiwara Masahiro, Iwata Yoshihiro, Takahashi Hiroyuki, Imai Koji, Yokoo Hideki, Ishitoya Shunta, Ogata Miki, Matsuno Naoto, Sumi Yasuo, Furukawa Hiroyuki
Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Asahikawa Medical University, 2-1, Midorigaoka-Higashi, Asahikawa, Hokkaido, Japan.
Department of Radiology, Asahikawa Medical University, Asahikawa, Japan.
Surg Case Rep. 2021 Oct 30;7(1):234. doi: 10.1186/s40792-021-01317-1.
The damage control approach is known to reduce the mortality rate in severely injured patients and has now become a common practice. Transcatheter arterial embolization (TAE) has been shown to be useful with combining with damage control laparotomy in identifying and controlling active arterial hemorrhage. Hybrid operating room (OR) allows both damaged control surgery and TAE in the same location in minimal time. We report a case of a patient with three cardiac arrests who was saved by early intervention using damage control surgery (DCS) with interventional radiology (IVR) in the hybrid OR.
A 46-year-old woman was injured in a collision with a tree while snowboarding. She was eventually transported to hybrid operating room in our hospital with the diagnosis of significant liver laceration and hemorrhagic shock. Damage control surgery was performed with perihepatic packing (PHP) and TAE was conducted to stop active bleeding from right hepatic artery. She experienced 3 times of cardiopulmonary arrest, which was successfully resuscitated on each occasion. Although she had total of 3 times of laparotomy but tolerated well. She was discharged on day 82 of hospitalization and showed no neurological sequelae.
Saving the life of a patient with severe trauma requires a multidisciplinary approach with cooperation and early information sharing among trauma team members. Sharing treatment strategy with the trauma team and early intervention using DCS with IVR in the hybrid operating room could save the patient's life.
损伤控制方法已被证实可降低重伤患者的死亡率，现已成为一种常见的治疗手段。经导管动脉栓塞术（TAE）已被证明与损伤控制剖腹术联合使用，在识别和控制活动性动脉出血方面是有效的。杂交手术室（OR）能够在最短时间内，在同一地点同时进行损伤控制手术和TAE。我们报告了一例患者，该患者发生了三次心脏骤停，通过在杂交手术室中采用损伤控制手术（DCS）联合介入放射学（IVR）的早期干预得以挽救。
一名46岁女性在滑雪时与一棵树相撞受伤。她最终被送往我院杂交手术室，诊断为严重肝裂伤和失血性休克。进行了损伤控制手术，采用肝周填塞（PHP），并实施TAE以阻止右肝动脉的活动性出血。她经历了3次心肺骤停，每次均成功复苏。尽管她总共接受了3次剖腹手术，但耐受性良好。她在住院第82天出院，未出现神经后遗症。
挽救严重创伤患者的生命需要多学科方法，创伤团队成员之间要相互合作并尽早共享信息。与创伤团队共享治疗策略，并在杂交手术室中采用DCS联合IVR进行早期干预，可挽救患者生命。
