22nd European Congress of Trauma & Emergency Surgery

Prof.

Chairs

Traumatic retroperitoneal hematomas in zone I. Do we have to explore them all?

Abstract text (incl. references and figure legends) INTRODUCTION Traumatic retroperitoneal hematomas (TRH) are a frequent entity with a high mortality rate in severe polytraumatized patients. The objective of this study was to evaluate the results of the management of TRH in Zone I in our center, with special focus on its systematic exploration. MATERIAL &amp; METHODS Retrospective observational study, with patients included in a prospective severe trauma registry, with TRH in Zone I. RESULTS Between 1993 and 2021, 290 patients with TRH were collected, 37 (12.7%) were located in Zone I, 28 of them due to blunt trauma (BTRH) (75.6%), and 9 due to penetrating trauma (PTRH) (24.4 %). The most frequent mechanism of injury in BTRH has been precipitation (35.7%), followed by vehicle collision (25%), run over (21.4%), motorcycle collision (14.2%), and others (3.5%). In PTRH, 66.7% stab wounds and 33.3% gunshot wound are collected. 25 patients (67.5%) underwent surgery, 16 for BTRH and 9 for PTRH. In 6 cases due to hemodynamic instability and in 19 due to CT findings. 17 (68%) died, 14 due to uncontrolled bleeding and 3 due to multifactorial causes. In 3 cases the hematoma was not explored, one of them died due to inadvertent aortic injury, and the other 2 required reintervention, one due to pancreatic injury and the other due to duodenopancreatic and IVC injury. Of the 12 who did not undergo surgery, 5 (41.6%) died, 3 due to bleeding and 2 due to other causes. The 7 who survived had 2 aortic lesions treated with endoprosthesis, 2 IVC lesions that underwent cavography without contrast leakage, and 3 main aortic branches treated by angioembolization. None of them required reintervention due to bleeding or inadvertent injury. CONCLUSIONS In patients in whom TRH is diagnosed by CT, non-operative management is possible in selected patients, but in patients in whom the hematoma is found at laparotomy, exhaustive exploration is necessary to avoid inadvertent injuries that will determine high morbidity and mortality.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Polytrauma

Quick shot presentation

Laparoscopic surgery in abdominal trauma: A 6-year experience at a uk level I major trauma centre

Abstract text (incl. references and figure legends) Introduction: Laparoscopic surgery is now commonplace in both elective and emergency general surgery. However, the role of laparoscopy in trauma surgery is yet to be fully evaluated. Methods: This is a retrospective study between 2017-2022, including patients who underwent laparoscopic surgery for abdominal trauma. Patients were identified from a local prospectively maintained database and the Trauma Audit and Research Network (TARN). Baseline demographic and clinical data were collected, including age, gender, co-morbidities, type of injury, injury severity score (ISS), radiological findings, intraoperative findings, complications, mortality and length of stay. Results: A total number of 146 patients were included in the study, 90% (n=131) of which were males with an average age of 28 (21-44) years. The majority of patients (n =108) had penetrating injuries (mainly stabbings), and the remaining (n=38) had blunt injuries (mainly road traffic accidents). Intraoperatively, 93 patients had visceral injuries, 8 had vascular injuries, and 50 patients had no significant intra-abdominal injuries. The mortality rate was seen to be 1.4%. Complications were found in 39 patients, ranging between Clavien-Dindo ≤2 to 3b. The average length of stay was 6 days (4-11), where non-medical reasons were seen to be the reason for the increased length of stay in 10 patients. Conclusions: Laparoscopic surgery is a viable management option in selected patients following abdominal trauma with no initial haemodynamic abnormality. It is safe and offers the benefit of avoiding a laparotomy. References: Di Saverio et al. Trauma laparoscopy and the six w's: Why, where, who, when, what, and how? J Trauma Acute Care Surg. 2019:344-367 Vargas et al. Fully therapeutic laparoscopy for penetrating abdominal trauma in stable patients. Am J Surg. 2022:206-207 Koto et al. The Role of Laparoscopy in Penetrating Abdominal Trauma: Our Initial Experience. J Laparoendosc Adv Surg Tech A. 2015:730-6 Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Emergency surgery

Visceral trauma

CT-scan and surgical concordance in penetrating abdominal trauma

Abstract text (incl. references and figure legends) Objective: The management of penetrating abdominal trauma has greatly benefited from the development of computed tomography (CT-scan), particularly in stable patients (1,2). The aim of our study is to evaluate the overall diagnostic accuracy of preoperative CT for penetrating abdominal injuries. Material and methods: Between January 1, 2015, and January 1, 2022, 81 patients were hospitalized with penetrating abdominal trauma at the Sainte-Anne and Laveran Teaching Military Hospitals. Fifty-one stable patients managed with abdomino-pelvic CT-scan and abdominal surgery were included. Radiological and surgical data were collected on the computerized record and compared by descriptive analysis (sensitivity, specificity, positive and negative predictive value) and by evaluation of the CT-scan and surgical concordance using the Kripendorff alpha coefficient. Results: The cohort consisted mainly of men (n=45; 88%), 32 (62.7%) had stab wounds and 18 (35.3%) gunshot injuries. The median age was 36 years [25-47]. The median index of Injusry Severity Score (ISS) was 17 [10-26]. Excellent agreement was obtained for solid organs (⍺=0.801) with high sensitivity and specificity (81.8% and 96.6% respectively). The greatest discrepancies were obtained for hollow viscus injuries (⍺=0.262, sensitivity 53.3% and specificity 76.2%) and the diaphragm (⍺=0.673, sensitivity 75%, specificity 92.3%). Surgical exploration was non-therapeutic for 5 patients (9.8%). The failure rate of non-operative treatment was 10% (n=1). Conclusions: CT-scan detection of solid organ injuries in patients with penetrating abdominal injury is excellent. However, the detection of hollow viscus and diaphragm injuries remains a challenge with a risk of over- and under-diagnosis. Laparoscopic exploration should be able to supplement the shortcomings of CT. References : 1. Goodman CS. Am J Roentgenol. 2009;193(2):432‑7. 2. Sander A et al. Eur J Trauma Emerg Sur 2022;48(2):881‑9.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Evaluative and prognostic factors in the management of penetrating abdominal trauma

Abstract text (incl. references and figure legends) Background: The absolute numbers vary across global locations but the epidemiological fact remains unchanged - that penetrating injuries in particular, GSW related injury, are highly lethal.[1] In order to minimize the mortality rate associated with trauma, the factors affecting mortality should be evidenced to take care of patients. In the late years, the studies have been aimed at determining the preventable trauma cases [3, 4]. Further studies showed that in penetrating pediatric abdominal trauma, ISS and PATI score were the most important indicators found to be independently associated with morbidity [3]. Material and Methods: To carry out our study, we standardized the registration of trauma patients who were presented to University Hospital of Trauma in Tirana, Albania, with penetrating abdominal Injury in a period of time from January 2019 to July 2019. Results: Data was collected from the trauma registry of the University Hospital of Trauma, were 22.875 patients (71.4%) with the diagnosis of trauma out of a total of 32.037 patients admitted to the emergency department. 510 patients were selected according to specific inclusion criteria and patients with abdominal injuries were further selected., 102 patients were recorded with Penetrating Abdominal Trauma… Conclusion: The hemodynamic instability, ISS and PATI were found to have a significant effect on morbidity &amp; mortality in this study. Applicability and prognostic effects of both ISS and PATI in penetrating abdominal trauma are validated in this relatively small group of trauma patients as they were found to be correlated with each other and mortality.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

Education

A two-step approach for 3D-guided patient-specific corrective limb osteotomies

Abstract text (incl. references and figure legends) Background: Corrective osteotomy surgery for long bone anomalies can be very challenging since deformation of the bone is often present in three dimensions. We developed a two-step approach for 3D-planned corrective osteotomies which consists of a cutting and reposition guide in combination with a conventional osteosynthesis plate. This study aimed to assess accuracy of the achieved corrections using this two-step technique. Methods: All patients (≥12 years) treated for post-traumatic malunion with a two-step 3D-planned corrective osteotomy within our center in 2021 were prospectively included. Three-dimensional virtual models of the planned outcome and the clinically achieved outcome were obtained and aligned. Postoperative evaluation of the accuracy of performed corrections was assessed by measuring the preoperative and postoperative alignment error in terms of angulation, rotation and translation. Results: A total of 10 patients were included. All corrective osteotomies were performed according to the predetermined surgical plan without any complications. The preoperative deformities ranged from 7.1 to 27.5 in terms of angulation and 5.3 to 26.1° in terms of rotation. The achieved alignment deviated on average 2.1 ± 1.0 and 3.4 ± 1.6 degrees from the planning for the angulation and rotation, respectively. Conclusions: Atwo-step approach for 3D-guided patient-specific corrective limb osteotomies is reliable, feasibleand accurate. Figure 1: Workflow of a 3D-guided patient-specific corrective osteotomy using a two-step approach.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Skeletal trauma and sports medicine

Retrospective comparison of operative technique for chest wall injuries

Abstract text (incl. references and figure legends) INTRODUCTION: Surgical management of chest wall injuries is a common procedure. However, operative techniques are diverse and no universal guidelines exist for the procedure. There is a lack of studies comparing the outcome with different operative techniques for chest wall surgery. The aim of this study was to compare hospital outcomes regarding length of stay between patients operated for chest wall injuries with either a minimally invasive, muscle sparing method or a conventional method with large incisions and usually thoracotomy. MATERIAL AND METHODS: A retrospective study was made of all patients ≥18 years operated for chest wall injuries between 2010–2020. Patients were divided into two groups based on the surgery performed: a minimally invasive surgery (M-group) and a conventional surgery (C-group). Data on demographics, trauma, surgery and outcomes were extracted from patient records. Primary outcome was length of stay on mechanical ventilator (MV-LOS). Secondary outcomes were length of stay in intensive care (ICU-LOS) and in hospital (H-LOS), and complications such as reoperation, incidence of empyema, tracheostomy, pneumonia, and mortality. RESULTS: Of 311 included patients, 220 were in the C-group and 91 in the M-group. The groups had similar demographics and injuries. MV-LOS was 0 (0–65) in the C-group vs 0 (0–34) in the M-group (p&lt;0.001). ICU-LOS was 2 (0-67) in the C-group vs 0 (0-50) in the M-group (p&lt;0.001). H-LOS was 15 (5-113) in the C-group vs 11 (2-60) in the M-group (p&lt;0.001). Tracheostomy was performed in 49 (22.3%) patients in the C-group vs 5 (5.4%) in the M-group (p&lt;0.001). Pneumonia was diagnosed in 71 (32.3%) patients in the C-group vs 15 (16.1%) in the M-group (p=0.004). CONCLUSIONS: Our study indicates that surgical technique affects clinical outcomes for patients operated for chest wall injuries. A minimally invasive technique was shown to be favorable.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

The effect of surgical attire usage on the development of surgical site infections. A retrospective study

Abstract text (incl. references and figure legends) Aim: The present report aimed to examine the effectiveness of a surgical balaclava/hood styled cap for surgical site infections (SSI), compared to the use of a skull cap or bouffant styled cap among patients with proximal femur fracture (AO 31-A) who underwent intramedullary nail fixation. Central to this study was the hypothesis that the use of different types of surgical attire will not affect the occurrence of surgical site infections. Methods: 1431 patients were included for the study which were divided into two groups. One group was operated by the orthopedics department and the other group was operated by the surgery department. The occurrence or non-occurrence of surgical site infections was assessed by using a combination of possible cultures, reporting and medical letters. Surgical site infections were divided into deep wound infections (DWI) and superficial wound infections (SWI). Results: The occurrence of DWI was not significantly different between the two groups (1 patient in the orthopedics department vs 8 in the surgery department, p = 0.178). The occurrence of SWI was not significantly different between the two groups (3 patients in the orthopedics department vs 6 in the surgery department, p = 1.000). All other variables that could influence SSI did not differ significantly between the groups. Conclusions: No statistic significant difference was found in the development of SSI between the two groups. Looking at the cost effectiveness and sustainability, we could lower medical costs and lower our carbon footprint. The exact effect of surgical attire use and SSI deserves further study. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Management of splenic trauma in a UK major trauma centre: Decision making and clinical outcomes

Abstract text (incl. references and figure legends) Introduction: The AAST scale is widely used in grading splenic trauma, which are either managed conservatively, by splenic artery embolization (SAE), or operatively with spleen-preserving surgery (SPS) or splenectomy. How does the AAST grade influence decision making in management of splenic trauma? Materials &amp; Methods: A retrospective analysis was conducted of the prospective database of splenic trauma from a UK Major Trauma Centre between September 2015 and June 2022 (n= 211). Results: Of 211 patients, 14.7% had grade (G) 1, 31.8% G2, 21.3% G3, 15.6% G4 and 15.6% G5 splenic injuries. 88.6% had other coexisting injuries, primarily skeletal trauma (70%). Isolated splenic trauma were mainly G4 or G5 (52.5%), underwent splenectomy (43.5%) and had mortality of 4.4%, average length of stay (LOS) 7.5 days, and 30-day mortality/morbidity rate of 26%.[NO1] G1 and G2 injuries were mainly managed conservatively (71%,76%), and G4 and G5&quot;s mainly underwent splenectomy (48.5%,84.9%). SAE was most common in G4 injuries (30%), followed by G3 and G5 (15.6%,9.1%). Failure of conservative management was highest in G3 injuries with 8.7% progressing to splenectomy. No G3 SAE&quot;s required splenectomy. 10% of G4&quot;s and 66.7% of G5 SAE&quot;s [NO2] progressed to splenectomy. Overall, splenectomy patients had similar length of stay compared to SAE cohort (13.6 days vs 14.9 days), higher critical care admission (79.6% vs 33.3%) and 30-day mortality/morbidity (50.9% vs 45.8%) rates. No SPS managed injuries progressed to splenectomy. 54.6% of SPS were in G1 injuries, yet 63.6% required critical care, mortality rate was 9% and this cohort had the longest LOS at 17.6 days. Conclusion: Isolated high grade splenic injuries are uncommon but have good outcomes. G3 splenic injuries show good outcomes with SAE, however G4 and G5&quot;s were more likely to require operative management. SPS had outcomes disproportionate to grade of injuries which were attributable to coexisting injuries.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Non-operative management of severe liver injuries after blunt abdominal trauma – experiences from university medical center Ljubljana

Abstract text (incl. references and figure legends) Introduction: The liver is one of the most commonly injured parenchymal organs during blunt abdominal trauma. Sever liver injury is associated with significant morbidity and mortality. Hemodinamically stabile patients are now successfully treated with non-operative management (NOM). We present a case series of patients with sever liver injury due to blunt abdominal trauma that were successfully treated with NOM. Materials and methods: A single-center retrospective case series of nine patients (7 males, 2 females; median age 40 ± 25.1 years, range 9 – 83 years) after blunt abdominal trauma resulting in sever liver injury (AAST score 4 and 5) who were treated with NOM at the University Medical Center Ljubljana from April 2017 to July 2020 was performed. The evaluation of imaging, interventional and/or endoscopic interventions, complication rates and the length of hospital stay were recorded and evaluated. Results: Traffic accidents were the main cause of blunt abdominal trauma representing 44.5% of sever liver trauma, followed by the fall from the height (22.2%) and animal related injuries (22.2%). One case of unknown mechanism in a patient under influence of alcohol was recorded (11.1%). Concomitant injuries requiring surgical intervention were recorded in one patient. At the initial CT scan an active bleeding requiring embolization was present in three patients. Late complications requiring interventional and/or endoscopic interventions were noted in 55.5% (5/9 patients). The mean hospital stay was 38.4 ± 26.7 days (range 10 – 90 days). No morbidity was noted. Conclusions: Liver is one of the most commonly injured organs in the abdominal cavity. The management is complex and requires a multidisciplinary approach. Liver injuries, even severe ones, can be successfully treated with NOM.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Prof. Dr.

Aneurysmatic bone cyst of the humerus – Introduction of a new treatment technique and presentation of a case series

Abstract text (incl. references and figure legends) Introduction. Aneurysmatic bone cysts are described as benign but aggressively growing lesions, characterized by septate and blood-filled caverns. Especially in children and adolescents, they frequently lead to pathological fractures due to excessive destruction of the bone. Multiple therapeutic approaches e.g. curettage, radio therapy or phenol injections have been described. Literature reports local recurrence in 59%. Radical resection to prevent relapse leads to defects associated with functional impairment. Isolated or additive selective arterial embolization (SAE) of the supporting vessel is discussed as an alternative. We report a one-step treatment of aneurysmatic bone cysts of the proximal humerus providing both, a low relapse rate and good functional results. Methods. First, interventional angiography with coil-embolization of the supplying vessels is done. Subsequently, the tumor is surgically resected and debrided with a high-frequent milling machine. Reconstruction is then performed with an allogenic fibula and cancellous bone, no further implants are required. Data collection was managed through a retrospective study including patients diagnosed with &quot;aneurysmatic bone cyst of the proximal humerus&quot; in the past three years and their respective therapy. Results. In total, seven patients were treated with above described technique. Average age of all male patients was 7.6 years (range 3-10). One of them presented with a recurrence, in six patients the lesion healed with free functional outcome within the period of observation (85%). Intraoperatively, no relevant bleeding occurred. Conclusion. In 39% of the cases of isolated SAE, further embolization is required. For conventional techniques, literature reports recurrence rates of up to 59%. Our procedure minimizes the intraoperative risk of bleeding complications and lead to a distinctively decreased risk of recurrence (15%). We therefore expect radical follow up-resections to be rarely necessary. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Arthroscopically assisted treatment of acute acromioclavicular joint dislocation: Additional repair of acromioclavicular capsule yields to better results compared to coracoclavicular stabilization alone

Abstract text (incl. references and figure legends) Introduction: Biomechanical evidence raise the importance of acromioclavicular (AC) capsule for the proper function of AC joint complex. The aim of the study was to evaluate the results of arthroscopically assisted treatment of acute AC joint dislocation comparing two surgical techniques: double coracoclavicular (CC) stabilization alone versus additional direct AC capsule repair. Material &amp; Methods: Retrospective cohort study was conducted on forty-seven patients with acute AC joint dislocation grade Rockwood V. The first cohort (group A) of 22 patients (1 f/21 m; mean age 36,9, range 20-57) was treated with arthroscopically assisted technique using double suspension system for CC stabilization. The second cohort (group B) consisted of 25 patients (3 f/ 22 m; mean age 35,7, range 20-54) and was treated in same manner but with additional direct AC capsule repair using suture anchor. In both groups, deltotrapezoid fascia was repaired as well. At the follow up of 1 year radiological and functional results were evaluated. Bilateral anteroposterior (ap) view, modified Alexander view, relative constant score (CS), shoulder subjective value (SSV) and simple shoulder test (SST) were obtained. Results: Mean CC distance difference between healthy and affected side measured 2,7 mm in group A and 0,7 mm in group B. Dynamic posterior instability of AC joint was detected in 35% of patients in group A and 13% in group B. Functional results for group A and group B were: relative CS 85 vs 96, SSV 96 vs 95 and SST 11,6 vs 11,8 respectively. Functional results were not statistically different between the groups. Conclusions: Coracoclavicular stabilization with double suture-button suspension system with additional AC capsule repair yields to better results compared to the same CC stabilization alone. Complete repair of AC joint dislocation addressing the AC capsule shows better radiological results regarding static vertical and dynamic posterior instability.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Hyperbilirubinemia as a risk factor of the trauma ICU

Abstract text (incl. references and figure legends) Background: Hyperbilirubinemia is common in the intensive care unit (ICU). Hyperbilirubinemia has been considered as a risk factor of the ICU patient. Hyperbilirubinemia can have various causes. The hyperbilirubinemia has never been studied for the trauma ICU patient. The aim of this study is to elucidate the incidence and effects of the hyperbilirubinemia for the trauma ICU patient. Methods: Retrospective review of the Trauma ICU patients from 2017.01.01 to 2017.06.30. Initial bilirubin serum level, 48 hour bilirubin level, 7 day bilirubin level, highest bilirubin level, overall morbidity and mortality and other clinical variables were identified and evaluated. The patients who have highest bilirubin level &gt;= 3.0 mg/dl were defined as hyperbilirubinemia group. Results: A total 78 patients were enrolled in this study. Hyperbilirubinemia above serum bilirubin &gt;= 3.0 mg/dl were appeared in 26 patients. The mortality of the hyperbilirubinemia group was higher than the other group (71.4% vs 29.6%, p=0.03). The ICU stay of the hyperbilirubinemia group was longer than the other group (12.4 day vs 7.1 day, p=0.04). The hyperbilirubinemia group had more incidences of pneumonia, acute kidney injury, and sepsis than the other group (42.9% vs 57%, p=0.01/ 33.3% vs 66.7%, p=0.001/ 0% vs 100%, p&lt; 0.001). Conclusion: The hyperbilirubinemia is a risk factor of the trauma ICU. If the hyperbilirubinemia is appeared, the cause of the hyperbilirubinemia should be evaluated and make an effort to correct hyperbilirubinemia for the each cause of the hyperbilirubinemia.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) I do not have any disclosure.

PD Dr.

Caloric requirements in critically ill trauma patients as measured by indirect calorimetry: Changes over time and effect of clinical factors

Abstract text (incl. references and figure legends) Introduction: Nutrition is of paramount importance in critically ill trauma patients. However, adequate supply is difficult to achieve, as actual caloric requirements are not known and may change. Therefore, the current study aimed to investigate (1) caloric requirements over time and (2) the effect of clinical factors on requirements in critically ill trauma patients. Methods: Retrospective cohort study at tertiary trauma center including critically ill trauma patients who underwent indirect calorimetry (IC) 2012 - 2019. Caloric requirements were assessed as resting energy expenditure (REE) for 28 days during the ICU stay. REE over time and factors affecting REE were analyzed in cluster linear regression. Results were reported as regression coefficients (RC) with p-values. Results: A total of 129 patients were included. Median age was 56 y, 80% were male, BMI 26 kg/m2, and ISS 36. Median ICU length of stay was 12 days and 30-d mortality 11%. REE initially increased and subsequently decreased over time. (Fig. 1) Median REE per day was 2265 kcal (IQR 1934-2686). In univariable analysis, ISS was not significantly associated with REE over time (RC 0.03, p=0.600). Multivariable analysis revealed a significant REE increase (RC 0.62, p&lt;0.001) and subsequent decrease (RC -0.03, p&lt;0.001) over time, as well as age &lt;65 y (RC 2.07, p=0.018), male sex (RC 4.38, p&lt;0.001), no severe head trauma (RC 2.10, p=0.030) and BMI ≥35 kg/m2 (RC 6.94, p&lt;0.001) as independent predictors for higher REE over time. Conclusion: In critically ill trauma patients, caloric requirements as measured by IC significantly increased and subsequently decreased over time. Younger age, male sex, no severe head trauma, and higher BMI were identified as independent predictors for higher caloric requirements over time, whereas for injury severity, no significant association was found. These results may help to improve nutrition through the use of IC to estimate caloric requirements in critically ill trauma patients.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Placement of endovascular balloons in the inferior vena cava (REBOVC) and the aorta (REBOA) guided by ultrasound or fluoroscopy – A comparative study

Abstract text (incl. references and figure legends) Introduction: In fluoroscopy-free settings, alternative safe and quick methods for placing Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and Resuscitative Endovascular Balloon Occlusion of the Inferior Vena Cava (REBOVC) are needed. Ultrasound (US) is being increasingly used to guide the placement of REBOA in the absence of fluoroscopy (FL). Our hypothesis was that US could be used to adequately visualize and guide REBOVC positioning, without significant time-delay, when compared to FL guidance. Material and Methods: Ten anesthetized pigs were used to compare US-guided placement of supracoeliac REBOA and suprahepatic REBOVC with corresponding FL- guidance. Accuracy was controlled by FL. Four intervention groups: 1) FL REBOA 2) FL REBOVC 3) US REBOA and 4) US REBOVC were used. The aim was to carry out the four interventions in all animals. Randomization was performed to either FL or US guidance first. Time to position the balloons in the supracoeliac aorta or in the suprahepatic inferior vena cava was recorded and compared between the four intervention groups. Results: US-guided REBOA and REBOVC placement was completed in eight animals, respectively. All eight had correctly positioned REBOA and REBOVC on FL verification. FL-guided REBOA placement was slightly faster (median 14 sec, IQR 13-17 sec) than US-guided REBOA (median 22 sec, IQR 21-25 sec, p=0.024). The corresponding comparisons of the REBOVC groups were not statistically significant, with FL-guided REBOVC taking 19 seconds, median, (IQR 11-22 sec) and US-guided REBOVC taking 27 sec, median, (IQR 20-34 sec, p=0.19). Conclusions: US adequately and quickly guide the placement of supracoeliac REBOA and suprahepatic REBOVC in a porcine laboratory model. References: Wikström MB et al. A randomized porcine study of the hemodynamic and metabolic effects of combined endovascular occlusion of the vena cava and the aorta in normovolemia and in hemorrhagic shock. J Trauma Acute Care Surg. 2021.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

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