Journal of Trauma and Injury

Case Report

Successful laparotomy for intra-abdominal hypertension following veno-venous extracorporeal membrane oxygenation after severe thoracoabdominal trauma: a case report: Yo Huh, Jonghwan Moon, Kyoungwon Jung, Hye-Min Sohn; Received September 21, 2024 Accepted December 31, 2024 Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0060 [Epub ahead of print]

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Abstract PDF: Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is often used as a life-saving therapy for lung injuries; however, it presents challenges, including bleeding risks and potential reductions in ECMO flow. This case report details the intricate management of a 16-year-old boy who suffered severe thoracoabdominal trauma following a nine-floor fall. The patient sustained severe lung injury and damage to multiple solid organs, including liver lacerations, and was placed on VV-ECMO. When initiating ECMO, it is crucial to carefully consider anticoagulation to avoid potential bleeding complications. Therefore, despite the usual risks associated with ECMO, such as bleeding and reduced flow rates, anticoagulation was withheld due to the risk of hemorrhage from the liver injury. While on ECMO support, the patient experienced a sudden decrease in flow and blood pressure, suggesting an increase in intra-abdominal pressure. An immediate decompressive laparotomy revealed a significant hemoperitoneum, primarily caused by oozing from the liver laceration. The prompt recognition of abdominal distension and the timely decision to proceed with surgery without further imaging were key to the successful treatment. Postoperatively, the patient showed good recovery, with gradual weaning from ECMO, extubation, and eventual discharge. In conclusion, this case highlights the importance of ongoing monitoring for patients with complex trauma who are on ECMO. External factors, including elevated intra-abdominal pressure, can impair ECMO performance. Meticulous management and a multidisciplinary approach are essential in these intricate cases, which involve the nonsurgical treatment of solid organ damage accompanied by severe lung injury.; Summary

Review Article

Predictors of massive transfusion protocols activation in patients with trauma in Korea: a systematic review: Dongmin Seo, Inhae Heo, Juhong Park, Junsik Kwon, Hye-min Sohn, Kyoungwon Jung; J Trauma Inj. 2024;37(2):97-105. Published online June 14, 2024; DOI: https://doi.org/10.20408/jti.2024.0015

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Purpose
Massive transfusion protocols (MTPs) implementation improves clinical outcomes of the patient’s resuscitation with hemorrhagic trauma. Various predictive scoring system have been used and studied worldwide to improve clinical decision. However, such research has not yet been studied in Korea. This systematic review aimed to assess the predictors of MTPs activation in patients with trauma in Korea.
Methods
The PubMed, Embase, Cochrane Library, Research Information Sharing Service databases, KoreaMed, and KMbase were searched from November 2022. All studies conducted in Korea that utilized predictors of MTPs activation in adult patients with trauma were included.
Results
Ten articles were eligible for analysis, and the predictors were assessed. Clinical assessments such as systolic and diastolic blood pressure, shock index (SI), prehospital modified SI, modified early warning system (MEWS) and reverse SI multiplied by the Glasgow Coma Scale (rSIG) were used. Laboratory values such as lactate level, fibrinogen degradation product/fibrinogen ratio, and rotational thromboelastometry (ROTEM) were used. Imaging examinations such as pelvic bleeding score were used as predictors of MTPs activation.
Conclusions
Our systematic review identified predictors of MTPs activation in patients with trauma in Korea; predictions were performed using tools that requires clinical assessments, laboratory values or imaging examinations only. Among them, ROTEM, rSIG, MEWS, SI, and lactate level showed good effects for predictions of MTPs activation. The application of predictors for MTP’s activation should be individualized based on hospital resource and skill set, also should be performed as a clinical decision supporting tools.

Summary

Citations

Citations to this article as recorded by

A Case Study on Simulation Training for Operational Improvements in the Massive Transfusion Protocol
Sooin Choi, Jongbin Wee, Haeri Jung, Young Soon Cho
The Korean Journal of Blood Transfusion.2024; 35(2): 113. CrossRef

Case Report

Treatment of a penetrating inferior vena cava injury using doctor-helicopter emergency medical service and direct-to-operating room resuscitation in Korea: a case report: Dongmin Seo, Jieun Kim, Jiwon Kim, Inhae Heo, Jonghwan Moon, Kyoungwon Jung, Hohyung Jung; J Trauma Inj. 2024;37(1):74-78. Published online January 12, 2024; DOI: https://doi.org/10.20408/jti.2023.0055

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Abstract PDF: Inferior vena cava (IVC) injuries can have fatal outcomes and are associated with high mortality rates. Patients with IVC injuries require multiple procedures, including prehospital care, surgical techniques, and postoperative care. We present the case of a 67-year-old woman who stabbed herself in the abdomen with a knife, resulting in an infrarenal IVC injury. We shortened the transfer time by transporting the patient using a helicopter and decided to perform direct-to-operating room resuscitation by a trauma physician in the helicopter. The patient underwent laparotomy with IVC ligation for damage control during the first operation. The second- and third-look operations, including previous suture removal, IVC reconstruction, and IVC thrombectomy, were performed by a trauma surgeon specializing in cardiovascular diseases. The patient was discharged without major complications on the 19th postoperative day with rivaroxaban as an anticoagulant medication. Computed tomography angiography at the outpatient clinic showed that thrombi in the IVC and both iliac veins had been completely removed. Patients with IVC injuries can be effectively treated using a trauma system that includes fast transportation by helicopter, damage control for rapid hemostasis, and expert treatment of IVC injuries.; Summary

Original Articles

Problems with Transferring Major Trauma Patients to Emergency Medical Center of a University Hospital from Another Medical Center: Sang Soo Han, Kyoungwon Jung, Junsik Kwon, Jiyoung Kim, Sang Cheon Choi, Kug Jong Lee; J Korean Soc Traumatol. 2011;24(2):118-124.

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Abstract PDF: PURPOSE
The incidence of multiple trauma is increasing nowadays and is the leading cause of death among young adults. Initial treatment is well known to be crucial in multiple trauma victims. However, many indiscriminate transfers occur due to the lack of a well-organized trauma system in Korea. The objective of this study is to demonstrate the current serious state in which major trauma patients are transferred to the Emergency Medical Center of a university hospital from another medical center.
METHODS
From November 2009 to October 2010, we performed a retrospective study to analyze the characteristics of patients who visited the Ajou University Medical Center located in Gyeonggi-do. We evaluated the ISS (injury severity score), and a score over 15 point was identified as major trauma. The major trauma patients were separated into two groups according to the visit route, and the characteristics of each group were analyzed.
RESULTS
Among the 88,862 patients who visited to the Emergency Medical Center, trauma patients accounted for 19,950, and 343 of them were evaluated as major trauma patients. Among the 343 patients, 170 patients had been transferred from other medical centers. The proportion of males to females was 3.3:1, and the mean ISS was 22.7. The leading cause of trauma was motor vehicle accidents. Of the total 170 patients, 77.6% were admitted to the Intensive care unit and 36.3% underwent surgery. The 170 patients that had been transferred to our medical center, 78.8% were transferred from Gyeonggi-do, 15.3% were transferred from other regions, and 5.9% were miscellaneous.
CONCLUSION
Almost half of the major trauma victims treat at our medical center had been transferred from other medical centers. Establishing a traumatic system, supported by well-organized trauma centers and emergency medical services, that can reduce inappropriate transfers among medical facilities is essential.; Summary

Experience with the Treatment of Patients with Major Trauma at the Department of Trauma Surgery in One Regional Emergency Medical Center for One Year: Taeyoen Kim, Kyoungwon Jung, Junsik Kwon, Jiyoung Kim, Suk ja Baek, Seo young Song, Chan suk Gang, Kug jong Lee; J Korean Soc Traumatol. 2011;24(1):37-44.

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Abstract PDF: PURPOSE
Recently, social interest in an organized trauma system for the treatment of patients has been increasing in government and academia and the establishment of trauma center is being considered across the country. However, establishing such a system has not been easy in Korea, because enormous experiences and resources are necessary. The objectives of this study were (1) to estimate a trauma patient's demands during the course of treatment and (2) to provide appropriate direction for trauma centers to be established in Korea.
METHODS
The records of 207 patients who were admitted to the Department of Trauma Surgery in Ajou University Medical Center due to trauma were retrospectively reviewed for a 1 year period from March 2010 to February 2011. Patients were reviewed for general characteristics, number of hospital days, numbers and kinds of surgeries, numbers and kinds of consultations, ISS (Injury Severity Score) and number of patients with ISS more than 15.
RESULTS
All 207 patients were enrolled. The average number of hospital days was 36.7 days. The ICU stay was 15.9 days, and the general ward stay was 20.8 days. Admitted patients occupied 9.02 beds in ICU and 11.80 beds in the general ward per day. The average number of surgeries per patient was 1.4, and surgery at the Department of Trauma Surgery was most common. Number of consultations per patient was 14.23, and consultations with orthopedic surgeons were most common. The average ISS was 18.6. The number of patients with ISS more than 15 was 141 (61.8%) and the average number of patients treated per trauma surgeon as a major trauma patient was 94.3. The number of mortalities was 20, and the mortality rate was 9.7%.
CONCLUSION
To reduce mortality and to provide proper treatment of patients with major trauma, hospitals need some number of beds, especially in the ICU, to treat patients and to prepare them for emergent surgery. An appropriate number of trauma surgeons and various specialists for consultation are also needed.; Summary

Case Report

Balloon Angioplasty for Budd-Chiari Syndrome Resulting from Primary Repair of an Inferior Vena Cava Injury: Joohyun Sim, Je Hwan Won, Kyoungwon Jung, Cook John Lee, Young Hwan Kim; J Trauma Inj. 2014;27(4):196-200.

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Abstract PDF: Budd-Chiari syndrome is an uncommon condition characterized by hepatic outflow obstruction. Direct suture of the injured Inferior vena cava in a patient with blunt hepatic trauma also may cause an equivalent condition. However, early diagnosis is possible with common symptoms and radiologic evaluation. Moreover, a transluminal approach with balloon angioplasty could prevent long-term complications of Budd-Chiari syndrome without repeated abdominal surgery.; Summary

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