International journal of surgery
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Major trauma is a leading cause of death, particularly amongst young patients. Conventional therapies for post-traumatic cardiovascular shock and acute pulmonary failure may sometimes be insufficient and even dangerous. New approaches to trauma care and novel salvage techniques are necessary to improve outcomes. ⋯ Moreover, we have identified several pre-ECLS patient characteristics useful in predicting ECLS treatment appropriateness in severe poly-traumatized patients. These might be helpful in deciding whether the ECLS should be initiated in patients who are severely complex and compromised. Future improvements in materials and techniques are expected to make ECLS even easier and safer to manage, leading to a further extension of its use in severely injured patients.
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Review Meta Analysis Comparative Study
Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric hip fractures: A overview of systematic reviews and update meta-analysis of randomized controlled trials.
Intertrochanteric hip fractures lead to high morbidity and mortality rates. As a minimally invasive technique, many studies reported the efficacy of PCCP for the treatment of intertrochanteric fractures, but the controversy still existed in some outcomes. The purpose of this study was to evaluate the efficacy of PCCP and DHS by a overview of systematic reviews and well-designed, comprehensive update meta-analysis. ⋯ PCCP is recommended to treat intertrochanteric hip fractures as an alternative minimally invasive method. More high-quality, randomized controlled trials that are adequately powered are needed to further evaluate the efficacy of PCCP and DHS.
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Review Meta Analysis Comparative Study
Percutaneous compression plate versus dynamic hip screw for treatment of intertrochanteric hip fractures: A overview of systematic reviews and update meta-analysis of randomized controlled trials.
Intertrochanteric hip fractures lead to high morbidity and mortality rates. As a minimally invasive technique, many studies reported the efficacy of PCCP for the treatment of intertrochanteric fractures, but the controversy still existed in some outcomes. The purpose of this study was to evaluate the efficacy of PCCP and DHS by a overview of systematic reviews and well-designed, comprehensive update meta-analysis. ⋯ PCCP is recommended to treat intertrochanteric hip fractures as an alternative minimally invasive method. More high-quality, randomized controlled trials that are adequately powered are needed to further evaluate the efficacy of PCCP and DHS.
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The appropriate resuscitation of patients in hemorrhagic shock is critical to improving survival. Current strategies for massive transfusions utilize fixed ratio protocols to rapidly deliver plasma and platelets to the patient. ⋯ Efforts are ongoing to provide patient-specific transfusion therapy in order to avoid excess transfusions. Thromboelastography (TEG) or Rotational Thromboelastometry (ROTEM) are two viscoelastic analyzers capable of providing Viscoelastic testing.
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The advent of cardiopulmonary resuscitation (CPR) revolutionized the care of patients with cardiac arrest, now allowing survival of up to 30% after out-of-hospital arrest due to arrhythmia; however, outcomes for cardiac arrest after trauma remain dismal, with less than 10% survival despite the most aggressive modern resuscitation techniques. The short time interval between cardiac arrest and brain ischemia, the reduced efficacy of CPR in the patient with profound hypovolemia due to hemorrhage, and the speed of exsanguination from major vascular injury all conspire to limit the effectiveness of standard CPR in the critically injured patient. Beginning in the 1980s, researchers began to harness the effects of profound hypothermia in order to extend the window of survivability after traumatic arrest, allowing the critical time needed to obtain surgical hemostasis in otherwise lethal exsanguinating injuries. ⋯ Rapid central arterial access is obtained and profound (<10 °C) hypothermia induced with aortic infusion of cold saline. During this window of up to 1 h, damage control surgical techniques are applied to control hemorrhage and repair injuries, followed by controlled rewarming and reperfusion using cardiopulmonary bypass. In this review, we trace these techniques from their early theoretical development, through refinement in clinically relevant animal models, and into their present application in a currently-enrolling human clinical trial of EPR for cardiac arrest from trauma (EPR-CAT), as well as examine current topics, ongoing challenges, and future directions for emergency preservation and resuscitation research.