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Open Access 01-12-2019 | Central Nervous System Trauma | Research article

Preserve encephalus in surgery of trauma: online survey. (P.E.S.T.O)

Authors: Edoardo Picetti, Ronald V. Maier, Sandra Rossi, Andrew W. Kirkpatrick, Walter L. Biffl, Philip F. Stahel, Ernest E. Moore, Yoram Kluger, Gian Luca Baiocchi, Luca Ansaloni, Vanni Agnoletti, Fausto Catena

Published in: World Journal of Emergency Surgery | Issue 1/2019

Abstract

Background

Traumatic brain injury (TBI) is a global health problem. Extracranial hemorrhagic lesions needing emergency surgery adversely affect the outcome of TBI. We conducted an international survey regarding the acute phase management practices in TBI polytrauma patients.

Methods

A questionnaire was available on the World Society of Emergency Surgery website between December 2017 and February 2018. The main endpoints were the evaluation of (1) intracranial pressure (ICP) monitoring during extracranial emergency surgery (EES), (2) hemodynamic management without ICP monitoring during EES, (3) coagulation management, and (4) utilization of simultaneous multisystem surgery (SMS).

Results

The respondents were 122 representing 105 trauma centers worldwide. ICP monitoring was utilized in 10–30% of patients at risk of intracranial hypertension (IH) undergoing EES from about a third of the respondents [n = 35 (29%)]. The respondents reported that the safest values of systolic blood pressure during EES in patients at risk of IH were 90–100 mmHg [n = 35 (29%)] and 100–110 mmHg [n = 35 (29%)]. The safest values of mean arterial pressure during EES in patients at risk of IH were > 70 mmHg [n = 44 (36%)] and > 80 mmHg [n = 32 (26%)]. Regarding ICP placement, a large percentage of respondents considered a platelet (PLT) count > 50,000/mm³ [n = 57 (47%)] and a prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 73 (60%)] to be the safest parameters. For craniotomy, the majority of respondents considered PLT count > 100,000/mm³ [n = 67 (55%)] and a PT/aPTT < 1.5 times the normal control [n = 76 (62%)] to be the safest parameters. Almost half of the respondents [n = 53 (43%)], reported that they transfused red blood cells (RBCs)/plasma (P)/PLTs at a ratio of 1/1/1 in TBI polytrauma patients. SMS was performed in 5–19% of patients, requiring both an emergency neurosurgical operation and EES, by almost half of the respondents [n = 49 (40%)].

Conclusions

A great variability in practices during the acute phase management of polytrauma patients with severe TBI was identified. These findings may be helpful for future investigations and educational purposes.

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Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A et al. InTBIR Participants and Investigators. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16(12): 987–1048.

Teixeira PG, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007;63(6):1338–46.PubMed

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128.PubMed

Duchesne JC, McSwain NE Jr, Cotton BA, Hunt JP, Dellavolpe J, Lafaro K, et al. Damage control resuscitation: the new face of damage control. J Trauma. 2010;69(4):976–90.PubMed

Chovanes J, Cannon JW, Nunez TC. The evolution of damage control surgery. Surg Clin North Am. 2012;92:859–75.PubMed

Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern Association for the Surgery of trauma. J Trauma Acute Care Surg. 2017;82(3):605–17.PubMed

Galvagno SM Jr, Fox EE, Appana SN, Baraniuk S, Bosarge PL, Bulger EM et al PROPPR Study Group. Outcomes after concomitant traumatic brain injury and hemorrhagic shock: a secondary analysis from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios trial. J Trauma Acute Care Surg 2017; 83(4): 668–674.

Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15.PubMed

Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care. 2016;20:100.PubMed

10.

Marmarou A, Eisenberg HM, Foulkes MA, Marshall LF, Jane JA. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg. 1991;75(1S):S59–66.

11.

Vik A, Nag T, Fredriksli OA, Skandsen T, Moen KG, Schirmer-Mikalsen K, et al. Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury. J Neurosurg. 2008;109(4):678–84.PubMed

12.

Güiza F, Depreitere B, Piper I, Citerio G, Chambers I, Jones PA, et al. Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury. Intensive Care Med. 2015;41(6):1067–76.PubMed

13.

Smith M. Monitoring intracranial pressure in traumatic brain injury. Anesth Analg. 2008;106(1):240–8.PubMed

14.

Servadei F, Picetti E. Intracranial pressure monitoring and outcome in traumatic brain injury: the probe does matter? World Neurosurg. 2015;83(5):732–3.PubMed

15.

Picetti E, Iaccarino C, Servadei F. Letter: Guidelines for the management of severe traumatic brain injury fourth ddition. Neurosurgery. 2017;81(1):E2.PubMed

16.

Stocchetti N, Picetti E, Berardino M, Buki A, Chesnut RM, Fountas KN, et al. Clinical applications of intracranial pressure monitoring in traumatic brain injury : report of the Milan consensus conference. Acta Neurochir. 2014;156(8):1615–22.PubMed

17.

Chesnut R, Videtta W, Vespa P, Le Roux P Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring. Intracranial pressure monitoring: fundamental considerations and rationale for monitoring Neurocrit Care 2014; 21 Suppl 2: S64–S84.

18.

Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W et al Global Neurotrauma research group. A trial of intracranial pressure monitoring in traumatic brain injury N Engl J Med 2012; 367: 2471–2481.

19.

Fujita Y, Algarra NN, Vavilala MS, Prathep S, Prapruettham S, Sharma D. Intraoperative secondary insults during extracranial surgery in children with traumatic brain injury. Childs Nerv Syst. 2014;30(7):1201–8.PubMed

20.

Algarra NN, Lele AV, Prathep S, Souter MJ, Vavilala MS, Qiu Q, et al. Intraoperative secondary insults during orthopedic surgery in traumatic brain injury. J Neurosurg Anesthesiol. 2017;29(3):228–35.PubMed

21.

Kinoshita T, Yamakawa K, Yoshimura J, Watanabe A, Matsumura Y, Ito K et al. And on behalf of the Japanese Association for Hybrid Emergency Room System (JA-HERS) Scientific Promotion Committee. First clinical experiences of concurrent bleeding control and intracranial pressure monitoring using a hybrid emergency room system in patients with multiple injuries. World J Emerg Surg 2018; 13: 56.

22.

Güiza F, Meyfroidt G, Piper I, Citerio G, Chambers I, Enblad P, et al. Cerebral perfusion pressure insults and associations with outcome in adult traumatic brain injury. J Neurotrauma. 2017;34(16):2425–31.PubMed

23.

MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55(1):39–44.PubMed

24.

Allard CB, Scarpelini S, Rhind SG, Baker AJ, Shek PN, Tien H, et al. Abnormal coagulation tests are associated with progression of traumatic intracranial hemorrhage. J Trauma. 2009;67(5):959–67.PubMed

25.

Yuan Q, Sun YR, Wu X, Yu J, Li ZQ, Du ZY, et al. Coagulopathy in traumatic brain injury and its correlation with progressive hemorrhagic injury: a systematic review and meta-analysis. J Neurotrauma. 2016;33(14):1279–91.PubMed

26.

Holcomb JB, del Junco DJ, Fox EE, Wade CE, Cohen MJ, Schreiber MA et Al. PROMMTT Study Group. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg 2013; 148(2): 127–136.

27.

Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM et Al. PROPPR Study Group. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015; 313(5): 471–482.

28.

Moore JM, Thomas PA, Gruen RL, Chan P, Rosenfeld JV. Simultaneous multisystem surgery: an important capability for the civilian trauma hospital. Clin Neurol Neurosurg. 2016;148:13–6.PubMed

29.

Kinoshita T, Hayashi M, Yamakawa K, Watanabe A, Yoshimura J, Hamasaki T, et al. Effect of the hybrid emergency room system on functional outcome in patients with severe traumatic brain injury. World Neurosurg. 2018;118:e792–9.PubMed

30.

Carver D, Kirkpatrick AW, D'Amours S, Hameed SM, Beveridge J, Ball CG. A prospective evaluation of the utility of a hybrid operating suite for severely injured patients: overstated or underutilized? Ann Surg. 2018; [Epub ahead of print].

31.

Moore EE, Moore HB, Chapman MP, Gonzalez E, Sauaia A. Goal-directed hemostatic resuscitation for trauma induced coagulopathy: maintaining homeostasis. J Trauma Acute Care Surg. 2018;84(6S Suppl 1):S35–40.PubMed

32.

Gonzalez E, Moore EE, Moore HB. Management of trauma-induced coagulopathy with thrombelastography. Crit Care Clin. 2017;33(1):119–34.PubMed

33.

Weinberger J, Cipolle M. Optimal reversal of novel anticoagulants in trauma. Crit Care Clin. 2017;33(1):135–52.PubMed

Title: Preserve encephalus in surgery of trauma: online survey. (P.E.S.T.O)
Authors: Edoardo Picetti
Ronald V. Maier
Sandra Rossi
Andrew W. Kirkpatrick
Walter L. Biffl
Philip F. Stahel
Ernest E. Moore
Yoram Kluger
Gian Luca Baiocchi
Luca Ansaloni
Vanni Agnoletti
Fausto Catena
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Central Nervous System Trauma
Craniotomy
Polytrauma
Intracranial Hypertension
Polytrauma
Published in: World Journal of Emergency Surgery / Issue 1/2019
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-019-0229-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preserve encephalus in surgery of trauma: online survey. (P.E.S.T.O)

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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