The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation

Akiyoshi Hagiwara, Atsuo Murata, Takeaki Matsuda, Hiroharu Matsuda, Shuji Shimazaki, Thomas M. Scalea, Michael L Hawkins, Reuven Rabinovici

Research output: Contribution to journalArticle

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Abstract

Background: This study aimed to determine whether nonsurgical management using transcatheter arterial embolization (TAE) is safe for patients with blunt multiple trauma who transiently respond to the initial fluid resuscitation. Methods: Contrast computed tomography was performed for patients with blunt abdominal injuries, excluding those who did not respond to initial fluid resuscitation. Angiography was performed for patients with injuries showing contrast extravasation or solid organ injury classified, according to the American Association for the Surgery of Trauma, as grade 3 or higher on computed tomography. Transcatheter arterial embolization was performed when angiography showed arterial extravasation. The protocol was abandoned for any patients who became profoundly hypotensive (with systolic blood pressure 60 mm Hg or lower) during computed tomography or angiography. Results: Between January 2000 and December 2002, 269 patients with blunt abdominal injuries underwent TAE immediately after admission. Of these patients, 41 had injuries in at least two regions and underwent TAE for these regions. Among them, 22 patients were hemodynamically stable or showed rapid response to fluid resuscitation. The nonsurgical treatment was successful in all these cases. The remaining 19 patients (Injury Severity Score, 37.3 ± 8.2), who showed a transient response, were the subjects of this study. Of these patients, 15 underwent TAE for injuries in two regions (13 pelvic fractures, 7 splenic injuries, 6 hepatic injuries, 3 facial bleeding, and 1 renal injury), and 4 patients underwent TAE for injuries in three regions (4 had splenic injuries, 3 hepatic injuries, 2 renal injuries, 2 pelvic fractures, and 1 facial bleeding). For all these patients, TAE was successfully performed. Before TAE, the systolic blood pressure was 79.9 ± 8.4 mm Hg, and the shock index was 1.45 ± 0.25 mm Hg. After TAE, the corresponding values were 120.6 ± 19.3 mm Hg and 0.87 ± 0.16 mm Hg, respectively (p < 0.001). The rate of fluid administration required after TAE (214.2 ± 139.3 mL/hour) was significantly less than that required before TAE (1244.2 ± 347.1 mL/hour; range, 632-1,728 mL/hour) (p < 0.001). The deaths of two patients were classified as nonpreventable on the basis of the Trauma and Injury Severity Score (TRISS), and their respective probabilities of survival were determined to be 0.13 and 0.03. Conclusion: Nonsurgical management using TAE can be performed safely even for patients with blunt multiple trauma who are in hemorrhagic hypotension if their hemodynamics are improved by resuscitation with 2 L of fluid.

Original languageEnglish (US)
Pages (from-to)271-277
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume57
Issue number2
DOIs
StatePublished - Aug 1 2004

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Multiple Trauma
Resuscitation
Wounds and Injuries
Blood Pressure
Abdominal Injuries
Nonpenetrating Wounds
Injury Severity Score
Angiography
Tomography
Facial Injuries
Hemorrhage
Kidney
Liver
Pelvis
Hypotension
Shock
Hemodynamics

Keywords

  • Angiography
  • Multiple trauma
  • Transcatheter arterial embolization

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation. / Hagiwara, Akiyoshi; Murata, Atsuo; Matsuda, Takeaki; Matsuda, Hiroharu; Shimazaki, Shuji; Scalea, Thomas M.; Hawkins, Michael L; Rabinovici, Reuven.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 57, No. 2, 01.08.2004, p. 271-277.

Research output: Contribution to journalArticle

Hagiwara, Akiyoshi ; Murata, Atsuo ; Matsuda, Takeaki ; Matsuda, Hiroharu ; Shimazaki, Shuji ; Scalea, Thomas M. ; Hawkins, Michael L ; Rabinovici, Reuven. / The usefulness of transcatheter arterial embolization for patients with blunt polytrauma showing transient response to fluid resuscitation. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 57, No. 2. pp. 271-277.
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AU - Hagiwara, Akiyoshi

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AU - Matsuda, Takeaki

AU - Matsuda, Hiroharu

AU - Shimazaki, Shuji

AU - Scalea, Thomas M.

AU - Hawkins, Michael L

AU - Rabinovici, Reuven

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N2 - Background: This study aimed to determine whether nonsurgical management using transcatheter arterial embolization (TAE) is safe for patients with blunt multiple trauma who transiently respond to the initial fluid resuscitation. Methods: Contrast computed tomography was performed for patients with blunt abdominal injuries, excluding those who did not respond to initial fluid resuscitation. Angiography was performed for patients with injuries showing contrast extravasation or solid organ injury classified, according to the American Association for the Surgery of Trauma, as grade 3 or higher on computed tomography. Transcatheter arterial embolization was performed when angiography showed arterial extravasation. The protocol was abandoned for any patients who became profoundly hypotensive (with systolic blood pressure 60 mm Hg or lower) during computed tomography or angiography. Results: Between January 2000 and December 2002, 269 patients with blunt abdominal injuries underwent TAE immediately after admission. Of these patients, 41 had injuries in at least two regions and underwent TAE for these regions. Among them, 22 patients were hemodynamically stable or showed rapid response to fluid resuscitation. The nonsurgical treatment was successful in all these cases. The remaining 19 patients (Injury Severity Score, 37.3 ± 8.2), who showed a transient response, were the subjects of this study. Of these patients, 15 underwent TAE for injuries in two regions (13 pelvic fractures, 7 splenic injuries, 6 hepatic injuries, 3 facial bleeding, and 1 renal injury), and 4 patients underwent TAE for injuries in three regions (4 had splenic injuries, 3 hepatic injuries, 2 renal injuries, 2 pelvic fractures, and 1 facial bleeding). For all these patients, TAE was successfully performed. Before TAE, the systolic blood pressure was 79.9 ± 8.4 mm Hg, and the shock index was 1.45 ± 0.25 mm Hg. After TAE, the corresponding values were 120.6 ± 19.3 mm Hg and 0.87 ± 0.16 mm Hg, respectively (p < 0.001). The rate of fluid administration required after TAE (214.2 ± 139.3 mL/hour) was significantly less than that required before TAE (1244.2 ± 347.1 mL/hour; range, 632-1,728 mL/hour) (p < 0.001). The deaths of two patients were classified as nonpreventable on the basis of the Trauma and Injury Severity Score (TRISS), and their respective probabilities of survival were determined to be 0.13 and 0.03. Conclusion: Nonsurgical management using TAE can be performed safely even for patients with blunt multiple trauma who are in hemorrhagic hypotension if their hemodynamics are improved by resuscitation with 2 L of fluid.

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