BACKGROUND: Early hemorrhage control is essential to optimal trauma care. Hybrid operating rooms offer early, concomitant performance of advanced angiographic and operative hemostasis techniques, but their clinical impact is unclear. Herein, we present our initial experience with a dedicated, trauma hybrid operating room. STUDY DESIGN: This retrospective cohort analysis of 292 adult trauma patients undergoing immediate surgery at a Level I trauma center compared patients managed after implementation of a dedicated, trauma hybrid operating room (n = 186) with historic controls (n = 106). The primary outcomes were time to hemorrhage control (systolic blood pressure ≥ 100 mmHg without ongoing vasopressor or transfusion requirements), early blood product administration, and complication. RESULTS: Patient characteristics were similar between cohorts (age 41 years, 25% female, 38% penetrating trauma). The hybrid cohort had lower initial hemoglobin (10.2 vs 11.1 g/dL, p = 0.001) and a greater proportion of patients undergoing resuscitative endovascular balloon occlusion of the aorta (9% vs 1%, p = 0.007). Cohorts had similar case mixes and intraoperative consultation with cardiothoracic or vascular surgery (13%). Twenty-one percent of all hybrid cases included angiography. The interval between operating room arrival and hemorrhage control was shorter in the hybrid cohort (49 vs 60 minutes, p = 0.005). From 4 to 24 hours after arrival, the hybrid cohort had fewer red cell (0.0 vs 1.0, p = 0.001) and plasma transfusions (0.0 vs 1.0, p < 0.001). The hybrid cohort had fewer infectious complications (15% vs 27%, p = 0.009) and ventilator days (2.0 vs 3.0, p = 0.011), and similar in-hospital mortality (13% vs 10%, p = 0.579). CONCLUSIONS: Implementation of a dedicated, trauma hybrid operating room was associated with earlier hemorrhage control and fewer early blood transfusions, infectious complications, and ventilator days.
BACKGROUND: Early hemorrhage control is essential to optimal trauma care. Hybrid operating rooms offer early, concomitant performance of advanced angiographic and operative hemostasis techniques, but their clinical impact is unclear. Herein, we present our initial experience with a dedicated, trauma hybrid operating room. STUDY DESIGN: This retrospective cohort analysis of 292 adult trauma patients undergoing immediate surgery at a Level I trauma center compared patients managed after implementation of a dedicated, trauma hybrid operating room (n = 186) with historic controls (n = 106). The primary outcomes were time to hemorrhage control (systolic blood pressure ≥ 100 mmHg without ongoing vasopressor or transfusion requirements), early blood product administration, and complication. RESULTS: Patient characteristics were similar between cohorts (age 41 years, 25% female, 38% penetrating trauma). The hybrid cohort had lower initial hemoglobin (10.2 vs 11.1 g/dL, p = 0.001) and a greater proportion of patients undergoing resuscitative endovascular balloon occlusion of the aorta (9% vs 1%, p = 0.007). Cohorts had similar case mixes and intraoperative consultation with cardiothoracic or vascular surgery (13%). Twenty-one percent of all hybrid cases included angiography. The interval between operating room arrival and hemorrhage control was shorter in the hybrid cohort (49 vs 60 minutes, p = 0.005). From 4 to 24 hours after arrival, the hybrid cohort had fewer red cell (0.0 vs 1.0, p = 0.001) and plasma transfusions (0.0 vs 1.0, p < 0.001). The hybrid cohort had fewer infectious complications (15% vs 27%, p = 0.009) and ventilator days (2.0 vs 3.0, p = 0.011), and similar in-hospital mortality (13% vs 10%, p = 0.579). CONCLUSIONS: Implementation of a dedicated, trauma hybrid operating room was associated with earlier hemorrhage control and fewer early blood transfusions, infectious complications, and ventilator days.
Authors: Kyle J Kalkwarf; Stacy A Drake; Yijiong Yang; Caitlin Thetford; Lauren Myers; Morgan Brock; Dwayne A Wolf; David Persse; Charles E Wade; John B Holcomb Journal: J Trauma Acute Care Surg Date: 2020-10 Impact factor: 3.313
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Authors: Federico Coccolini; Marco Ceresoli; David T McGreevy; Mitra Sadeghi; Artai Pirouzram; Asko Toivola; Per Skoog; Koji Idoguchi; Yuri Kon; Tokiya Ishida; Yosuke Matsumura; Junichi Matsumoto; Viktor Reva; Mariusz Maszkowski; Paola Fugazzola; Matteo Tomasoni; Enrico Cicuttin; Luca Ansaloni; Claudia Zaghi; Maria Grazia Sibilla; Camilla Cremonini; Adam Bersztel; Eva-Corina Caragounis; Mårten Falkenberg; Lauri Handolin; George Oosthuizen; Endre Szarka; Vassil Manchev; Tongporn Wannatoop; Sung Wook Chang; Boris Kessel; Dan Hebron; Gad Shaked; Miklosh Bala; Carlos A Ordoñez; Peter Hibert-Carius; Massimo Chiarugi; Kristofer F Nilsson; Thomas Larzon; Emiliano Gamberini; Vanni Agnoletti; Fausto Catena; Tal M Hörer Journal: Updates Surg Date: 2020-03-04
Authors: D B Hoyt; E M Bulger; M M Knudson; J Morris; R Ierardi; H J Sugerman; S R Shackford; J Landercasper; R J Winchell; G Jurkovich Journal: J Trauma Date: 1994-09
Authors: Michael A Vella; Ryan Peter Dumas; Joseph DuBose; Jonathan Morrison; Thomas Scalea; Laura Moore; Jeanette Podbielski; Kenji Inaba; Alice Piccinini; David S Kauvar; Valorie L Baggenstoss; Chance Spalding; Charles Fox; Ernest E Moore; Jeremy W Cannon Journal: Trauma Surg Acute Care Open Date: 2019-11-11
Authors: Falco Hietbrink; Shahin Mohseni; Diego Mariani; Päl Aksel Naess; Cristina Rey-Valcárcel; Alan Biloslavo; Gary A Bass; Susan I Brundage; Henrique Alexandrino; Ruben Peralta; Luke P H Leenen; Tina Gaarder Journal: Eur J Trauma Emerg Surg Date: 2022-07-07 Impact factor: 2.374