Discover and read the best of Twitter Threads about #REBOA
Most recents (8)
Session 1 : Starting with recapping #latest evidence in #ECPR with Drs James Raitt, Stuart Gilon, and Dr Nick Barrett with @doctorbrijpatel #UKECPR23 @Novicelearner9 @djlowcock @tamish @DineshCallum @MLSCourse
Dr James Raitt - Cons in EM and PHEM at Thames Valley Air Ambulance - cardiac arrest ; where are we now? #UKECPR23
Wie bewerte ich diese ⬇️ Ergebnisse des @UKREBOATrial ? Ein paar lose Gedanken dazu. 🧵
Zunächst: das ist eine extrem gut gemachte Studie unter maximal anspruchsvollen Bedingungen. Grosser Respekt an @UKREBOATrial @MarionKCampbell @janjansenuk und das Team.
Huge congratulations on this fantastic trial in an extreme context.
Huge congratulations on this fantastic trial in an extreme context.
@robbielendrum hat es schon schön gesagt:
#REBOA 2h nach Trauma (90 min prähospital plus 30min im ED) steigert Mortalität.
#REBOA 2h nach Trauma (90 min prähospital plus 30min im ED) steigert Mortalität.
🚨🚑🚁🏥 Ergebnisse des @UKREBOATrial präsentiert am #CCR23:
Frage: Profitieren Patient:innen mit schwerstem Trauma und nicht kompressibler Torso-Blutung von Standard Care & #REBOA versus Standard Care ohne REBOA?
Design: prospektiv randomisierte multicenter Studie in den UK.
Frage: Profitieren Patient:innen mit schwerstem Trauma und nicht kompressibler Torso-Blutung von Standard Care & #REBOA versus Standard Care ohne REBOA?
Design: prospektiv randomisierte multicenter Studie in den UK.
Primary Outcome: 90 Tage Mortalität
Secondary Outcomes: Mortalität nach 3,6, 24 Stunden, in hospital, etc.
geplante Sample Size: 120
geplante Interimsanalysen nach 40 und 80 Patient:innen.
Abbruch der Studie nach der zweiten Interimsanalyse (90 Einschlüsse).
Secondary Outcomes: Mortalität nach 3,6, 24 Stunden, in hospital, etc.
geplante Sample Size: 120
geplante Interimsanalysen nach 40 und 80 Patient:innen.
Abbruch der Studie nach der zweiten Interimsanalyse (90 Einschlüsse).
Baseline Daten:
Medianes Alter 46 Interventionsgruppe,
39 Kontrollgruppe,
61/77 % männlich, >85% stumpfes Trauma,
Medianer ISS 41:
also eine Kohorte von wirklich Schwerstverletzten, wie wir sie auch in 🇪🇺 erwarten würden.
Medianes Alter 46 Interventionsgruppe,
39 Kontrollgruppe,
61/77 % männlich, >85% stumpfes Trauma,
Medianer ISS 41:
also eine Kohorte von wirklich Schwerstverletzten, wie wir sie auch in 🇪🇺 erwarten würden.
The Power of Industry in Medicine is tremendous, and the COST of speaking Truth to Power is real.
This is one example of how industry attempts to influence the narrative within medicine. @WesternTrauma
@prytimemedical - is the largest suppliers of REBOA catheter in the U.S.
🧵
This is one example of how industry attempts to influence the narrative within medicine. @WesternTrauma
@prytimemedical - is the largest suppliers of REBOA catheter in the U.S.
🧵
Dave Spencer, @prytimemedical CEO says in a letter put out on March 3rd that one of the “fundamental Core Values is transparency and open communication” at Prytime Medical.
Yet he privately sends a scathing letter emailed to @WesternTrauma Officers and Board of Directors: 👇
Yet he privately sends a scathing letter emailed to @WesternTrauma Officers and Board of Directors: 👇
This is based on a study that was done where the following abstract was submitted and accepted to @WesternTrauma:
"The Undisclosed Disclosures: The Dollar-Outcome Relationship in Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma"
"The Undisclosed Disclosures: The Dollar-Outcome Relationship in Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma"
1/🧵 This #Trauma #MorningPaper is a retrospective study of 284 cases of traumatic cardiac arrest (TCA) in Sweden, mostly men with mean age of 38. Are our attempts always futile? @SMHMajorTrauma @nottsurgeon @ShehanHett @karimbrohi @londonsdrcosmo @e1v1m1
sjtrem.biomedcentral.com/articles/10.11…
sjtrem.biomedcentral.com/articles/10.11…
2/ The study region has no #REBOA or prehospital resus thoracotomy services. 90.1% of TCA were prehospital with 64.8% from blunt injuries. Only 6.7% had shockable rhythm.
29.9% survived to ICU with mean days on ventilator of 3d. Only 10% survived to 30 days (GOS 3 or 4 mostly).
29.9% survived to ICU with mean days on ventilator of 3d. Only 10% survived to 30 days (GOS 3 or 4 mostly).
3/ In-hospital TCA had a much higher chance of survival (42.9% vs 7.0%) - but remember there is no prehospital thoracotomy/aortic compression/REBOA services, therefore I'm not sure how applicable this data is if setup were different. @viseshsankaran @traumakhan @WilsonMSJ
ICU stories (from the trenches): It's been a bit more than 2 hrs in your night shift & you are checking some labs signed out to you to be followed on. A rapid response is called for "agitation" in Rm 666; in less than a minute the operator calls for a "Code Blue" in the same room
When u arrive @ the code, u see a very young pt white as a sheet w CPR in progress. Presented to ED 12 h earlier c/o non-bloody emesis & abd pain x 1 wk. Uses daily NSAIDs for chronic pain. Vitals in ED: 125/77, HR 125, Hb 7.9 g/dl. Guaiac(+) stools. Vitals improved w hydration
and EGD was performed that showed "normal esophagus, large amount of food in the stomach, 6 mm non-bleeding antral ulcer & a large non-bleeding duodenal bulb ulcer". Evaluation was thought to be "limited" & plan was to repeat EGD next am. Back to the code, which is a PEA arrest
Let's focus again on potentially preventable death from torso #hemorrhage.
Our paper in @ShockJournal highlighted the need to refocus our efforts on the prehospital setting (🧵here: )
But can we ID those patients successfully who might need ARC? 🧵
Our paper in @ShockJournal highlighted the need to refocus our efforts on the prehospital setting (🧵here: )
But can we ID those patients successfully who might need ARC? 🧵
2/
We attempt to do so in this paper published in @JTraumAcuteSurg
Link here: journals.lww.com/jtrauma/Abstra…
Thanks to lead author @AhmerIrfanMBChB and coauthors at @uabmedicine for their hard work
We attempt to do so in this paper published in @JTraumAcuteSurg
Link here: journals.lww.com/jtrauma/Abstra…
Thanks to lead author @AhmerIrfanMBChB and coauthors at @uabmedicine for their hard work
3/
To recap: Advances of in-hospital care have been profound over the last >3 decades-those reaching alive & not in irreversible shock has a v reasonable survival chance.
A subset of patients (as high as 45% in some series) die in the field or w/i 1 hour of hospital arrival
To recap: Advances of in-hospital care have been profound over the last >3 decades-those reaching alive & not in irreversible shock has a v reasonable survival chance.
A subset of patients (as high as 45% in some series) die in the field or w/i 1 hour of hospital arrival
Just released in @TSACO_AAST: Clinical use of #REBOA in civilian trauma systems in the USA: joint statement from @ACSTrauma @EmergencyDocs @NAEMSP @NAEMSP (utilizing best available evidence & expert consensus opinion)
Full text: tsaco.bmj.com/content/4/1/e0…
Key points (thread): 1/x
Full text: tsaco.bmj.com/content/4/1/e0…
Key points (thread): 1/x
This document focuses on the use of REBOA
in civilian trauma patients & integration w/i
civilian trauma systems in the US. Emphasis
is on patient safety as the most important principle
while recognizing the variability in trauma systems, centers, and clinician training 2/x
in civilian trauma patients & integration w/i
civilian trauma systems in the US. Emphasis
is on patient safety as the most important principle
while recognizing the variability in trauma systems, centers, and clinician training 2/x
The quality of clinical evidence to support REBOA use in trauma
patients is poor with no Class I or II data demonstrating that it improves outcomes or survival compared with standard
treatment.
Many studies also do not report patient outcomes beyond the
initial resuscitation 3/x
patients is poor with no Class I or II data demonstrating that it improves outcomes or survival compared with standard
treatment.
Many studies also do not report patient outcomes beyond the
initial resuscitation 3/x
