From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Kirkpatrick, Clements); and the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Wong)
From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Kirkpatrick, Clements); and the Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Wong).
Can J Surg. 2022 Oct 25;65(5):E720-E726. doi: 10.1503/cjs.008921. Print 2022 Sep-Oct.
Open surgical and percutaneous endovascular procedures aimed at arresting traumatic life-threatening hemorrhage are usually performed in rapid serial fashion by surgeons and interventional radiologists; truly simultaneous procedures require modifications in technique, workflow and team collaboration. The primary objective of this study was to prospectively audit outcomes in patients with ongoing hemorrhage who underwent truly simultaneous open and percutaneous procedures.
We prospectively evaluated the cases of all severely injured patients who required an open and percutaneous procedure within the hybrid RAPTOR (resuscitation with angiography, percutaneous techniques and operative repair) suite at the Foothills Medical Centre, Calgary, Alberta, Canada, between Apr. 4, 2013, and Dec. 5, 2019. We compared outcomes between the truly simultaneous and rapid serial cases.
Thirty-five patients (31 [89%] male, median age 46 yr, median Injury Severity Score 30, blunt mechanism in 26 cases [74%]) underwent a hybrid intervention in the RAPTOR suite to stop ongoing hemorrhage during the study period. Twenty-three patients (66%) had a rapid serial procedure, and 12 (34%) had a truly simultaneous procedure. Demographic characteristics were similar between the 2 groups. Compared to the rapid serial group, a higher proportion of patients in the truly simultaneous group were hemodynamically unstable (11 [92%] v. 13 [56%], = 0.03) and required damage-control procedures (10 [83%] v. 12 [52%], = 0.03). The time from hospital arrival to procedure initiation was shorter for the truly simultaneous group (mean 31 min v. 59 min, = 0.02), and a lower proportion had initial radiologic studies (3 [25%] v. 16 [70%], = 0.01). The median hospital length of stay, intensive care unit stay and mortality rate were similar between the 2 groups.
Truly simultaneous open and percutaneous procedures to stop ongoing hemorrhage were unique in both patient and procedural details. For the most severely injured patients, the provision of truly simultaneous modalities is necessary to achieve clinical outcomes equivalent to those of less ill patients.
旨在控制创伤性危及生命的出血的开放式外科和经皮血管内手术通常由外科医生和介入放射科医生快速连续进行；真正的同步手术需要对技术、工作流程和团队协作进行修改。本研究的主要目的是前瞻性审核在接受持续出血的患者中进行真正同步开放和经皮手术的结果。
我们前瞻性评估了 2013 年 4 月 4 日至 2019 年 12 月 5 日期间在加拿大卡尔加里福溪医疗中心的 RAPTOR（血管造影、经皮技术和手术修复复苏）杂交套件中需要进行开放和经皮手术的所有严重受伤患者的病例。我们比较了真正同步和快速连续病例的结果。
在研究期间，35 名患者（31 名[89%]男性，中位年龄 46 岁，中位创伤严重程度评分 30 分，26 例[74%]为钝性机制）在 RAPTOR 套件中接受了混合干预以停止持续出血。23 名患者（66%）进行了快速连续手术，12 名患者（34%）进行了真正同步手术。两组的人口统计学特征相似。与快速连续组相比，真正同步组中更多的患者血流动力学不稳定（11[92%]比 13[56%]， = 0.03），需要进行损伤控制手术（10[83%]比 12[52%]， = 0.03）。真正同步组从入院到手术开始的时间更短（平均 31 分钟比 59 分钟， = 0.02），初始影像学研究的比例也较低（3[25%]比 16[70%]， = 0.01）。两组的住院时间、重症监护病房停留时间和死亡率相似。
真正同步的开放和经皮手术以停止持续出血在患者和手术细节上都是独特的。对于最严重受伤的患者，提供真正同步的方式对于实现与病情较轻的患者相当的临床结果是必要的。
