NEW YORK (Reuters Health) – Having an all-in-one trauma resuscitation room that includes whole-body CT, surgery, and interventional radiology can significantly reduce mortality in patients with severe trauma, researchers from Japan report.
“Our novel trauma workflow improved mortality in patients with severe trauma by reducing death from exsanguination,” Dr. Takahiro Kinoshita from Osaka General Medical Center told Reuters Health by email. “Most of the trauma surgeons believed the rapid surgery/intervention might improve outcome in bleeding trauma patients. However, there was only limited data to support this hypothesis.”
In 2011, Dr. Kinoshita and colleagues began using their “Hybrid ER” that includes a multi-slice interventional radiology (IVR)-CT system, a movable ultrasound, a monitoring screen, and a mechanical ventilator, which permits trauma-related examinations and life-saving procedures to be performed on the same table without patient transfer.
Their report is published online September 26 in Annals of Surgery.
In the first 4 years of use, 24% of the 336 patients treated in the Hybrid ER received IVR, compared with 17% of the 360 patients handled conventionally in the 4 years before the Hybrid ER was established. No patient in the Hybrid ER group underwent emergency surgery before CT or without CT, compared with 4% of patients in the conventional group.
Overall mortality was nominally lower in the Hybrid ER group than the conventional group at 24 hours (9% vs. 14%; P=0.07) – and significantly lower at 28 days (15% vs. 22%; P=0.028). The differences were attributable mostly to the Hybrid ER group’s advantage in mortality from exsanguination.
Hybrid ER patients had significantly shorter mean intervals from arrival at the trauma resuscitation room to the start of CT scanning (11 vs. 26 minutes) and to the beginning of emergency surgery (47 vs. 68 minutes), compared with the conventional group.
“The total cost of the Hybrid ER, including rebuilding the trauma resuscitation room, was 210 million yen (about $1.9 million) in our hospital,” Dr. Kinoshita said. “We believe this is not too expensive to save lives of severe trauma patients. In fact, nine trauma centers already have installed the Hybrid ER in Japan and Korea. Especially, it is reasonable to install the Hybrid ER system at the time of reconstruction of the trauma resuscitation room.”
“In our institution, all trauma surgeons have been trained to perform IVR during their residency and fellowship,” he added. “It enabled us to perform IVR quite early, as we don’t have to wait for a radiologist. We believe encouraging trauma surgeons to perform IVR may lead to the progress of trauma workflow worldwide.”
SOURCE: http://bit.ly/2hPQXED
Ann Surg 2017.
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