Poster Author of 1 e-Poster
SE-005 - Transcatheter arterial embolization for the treatment of severely injured patients with hemorrhagic shock.
Author of 1 Presentation
SE-005 - Transcatheter arterial embolization for the treatment of severely injured patients with hemorrhagic shock.
Abstract
Purpose
: To reappraise the role of transcatheter arterial embolization (TAE) in severely injured patients with hemorrhagic shock (HS).
Material and methods
Retrospective study including severely injured patients after blunt trauma admitted in HS in two level-I trauma centers. Physiological markers of hemorrhage, time-to-hemostasis, transfusion requirement, and mortality rates in ICU were recorded and analyzed. Patients undergoing first-line TAE were compared to those undergoing first-line open surgery (OS)
Results
202 patients were analyzed (125 TAE, 77 OS). The Injury Severity Score was similar in both groups (41 [32.5-50] vs. 38 [32.5-50]; p=0.25). Overall, 67% of TAE patients underwent pelvic embolization and 82% of OS patients had hemostatic laparotomy. Time-to-hemostasis was significantly shorter in OS patients (median 115 [60-160] vs.130 [100-180] minutes in TAE patients [p=0.04]), but it was not when patients undergoing whole-body CT (WBCT) were considered only (median 132 [100-180] vs. 150 [123-194] minutes in TAE and OS groups, respectively; p=0,09). Noticeably, 14 (11%) TAE patients had 2nd line OS, and 16 (21%) OS patients had 2nd line TAE. During the first 6-hours, OS patients received significantly more red blood cells units (median 6 [4-11] vs. 5 [3-8] in the TAE group, p=0.003). This difference disappeared after 24-hours. Overall, 52 (42%) and 37 (48%) patients died in ICU in the TAE and OS groups, respectively (p=0.39).
Conclusion
TAE should be considered as part of the hemostatic armamentarium in selected blunt trauma patients with hemorrhagic shock, preventing initial resuscitation measures enable performing WBCT. TAE and OS are complementary methods addressing different HS scenarios.