Citations

Citations to this article as recorded by  

• On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma
  A. I. Zhukov, N. N. Zadneprovsky, P. A. Ivanov, L. S. Kokov
  Russian Sklifosovsky Journal "Emergency Medical Ca.2024; 13(1): 14.     CrossRef

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

Extreme acidosis is a life-threatening physiological state that causes disturbances in the cardiovascular, pulmonary, immune, and hematological systems. Trauma patients commonly present to the operating room (OR) in hypovolemic shock, leading to tissue hypoperfusion and the development of acute metabolic acidosis with or without a respiratory component. It is often believed that trauma patients presenting to the OR in severe metabolic acidosis (pH <7.0) will have a nearly universal mortality rate despite aggressive resuscitation and damage control. The current literature does not include reports of successful resuscitations from a lower pH, which may lead providers to assume that a good outcome is not possible. However, here we describe a case of successful resuscitation from an initial pH of 6.5 with survival to discharge home 95 days after admission with almost full recovery. We describe the effects of acute acidosis on the respiratory and cardiovascular systems and hemostasis. Finally, we discuss the pillars of management in patients with extreme acute acidosis due to hemorrhage: transfusion, treatment of hyperkalemia, and consideration of buffering acidosis with bicarbonate and hyperventilation.

Citations

Citations to this article as recorded by  

• Prognosis of patients with extreme acidosis on admission to the emergency department: A retrospective cohort study
  Amichai Gutgold, Shaden Salameh, Jeries Nashashibi, Yonatan Gershinsky
  The American Journal of Emergency Medicine.2024; 76: 36.     CrossRef
• Thoracotomy Resuscitation of a Patient Who Sustained Blunt Force Trauma with a pH of 6.7 on Admission and Ultra Massive Transfusion of 42 Units of Blood
  John T. Meghreblian, A. J. Bethurum, Lou M. Smith
  The American Surgeon™.2024;[Epub]     CrossRef
• Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series
  Sasa Dragic, Danica Momcicevic, Biljana Zlojutro, Milka Jandric, Tijana Kovacevic, Vlado Djajic, Ognjen Gajic, Pedja Kovacevic
  Clinical Medicine Insights: Case Reports.2021; 14: 117954762110251.     CrossRef