Journal of Acute Care Surgery

Trauma, Procedure

Contemporary Utilization and Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Noncompressible Torso Hemorrhage in Korea: A Retrospective Multi-Center Study: Yoonjung Heo, Sung Wook Chang, Byungchul Yu, Byung Hee Kang, Pil Young Jung, Kyounghwan Kim, Dong Hun Kim; J Acute Care Surg 2024;14(1):16-26. Published online March 21, 2024; DOI: https://doi.org/10.17479/jacs.2024.14.1.16

Abstract
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Purpose
This study aimed to evaluate the utilization and outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in managing noncompressible torso hemorrhage (NCTH) among trauma patients in Korea. The evolution of REBOA and its impact on patient survival was investigated as well as predictors of mortality.
Methods
This retrospective study included 234 post-REBOA patients from 5 leading regional trauma centers across Korea between 2016 and 2021. Primary outcomes were in-hospital mortality, and secondary outcomes were various clinical parameters regarding REBOA, overall treatment flow, and complications. For comparative analyses, patients were dichotomized into in-hospital non-survivors or survivors. Then, generalized additive and linear regression models were used to evaluate the trend of in-hospital mortality.
Results
The overall in-hospital mortality was 65.4%. The survivors had a higher proportion of responders following REBOA (87.7% vs 62.7%, p < 0.001). Key variables influencing outcomes included total occlusion time, red blood cell transfusion volume within the first 24 hours, revised trauma score, and systolic blood pressure gap. These factors significantly correlated with mortality rates in multivariate logistic regression.
Conclusion
Over 6 years, survival rates for NCTH patients undergoing REBOA in Korea have shown improvement. Despite diverse REBOA protocols across institutions, the results underscore the need for continued research, standardized practices, and national quality control measures to further optimize patient outcome and establish more effective treatment protocols for NCTH.

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Trauma, Organ(liver, bowel, kideny etc.)

Management Trend for Unstable Pelvic Bone Fractures in Regional Trauma Centers: Multi-Institutional Study in the Republic of Korea: Byung Hee Kang, Kyoungwon Jung, Hongjin Shim, Dong Hun Kim; J Acute Care Surg 2022;12(3):103-110. Published online November 23, 2022; DOI: https://doi.org/10.17479/jacs.2022.12.3.103

Abstract
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Purpose
In the Republic of Korea, the use of trauma centers was recently adopted and is expected to have better outcome for severely injured patients. This study aimed to evaluate the clinical outcomes and treatment methods for unstable pelvic bone fractures in trauma centers.
Methods
The annual number of patients, clinical outcomes, and treatment methods of unstable pelvic bone fractures in three trauma centers from 2016 to 2020 were retrospectively reviewed. The patients were dichotomized into survivors and deceased, and demographic data, treatment, and clinical outcomes were compared. Multivariable analysis was performed to identify the factors associated with survival.
Results
Among 237 patients, 101 (42.6%) were deceased. Mortality was lower in the later period (2019- 2020) compared with the early period (2016-2018; 33.6% vs. 50.0%, p = 0.011). Direct admission of an increasing number of patients to trauma centers reduced prehospital time. Although the use of angioembolization in treating pelvic bone fracture (p < 0.001), and the use of other treatment methods did not change significantly (2016-2020). Lower age, lowest systolic blood pressure in the trauma bay, and higher lactate level, international normalized ratio, the amount of packed red blood cell transfusion at 24 hours were positively associated with mortality in the multivariate analysis.
Conclusion
Increasingly more patients with unstable pelvic bone fracture were admitted to trauma centers; mortality improved. Angioembolization increased significantly and multi-disciplinary modality for early bleeding control was still essential.

Citations

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Young–Burgess Classification of Pelvic Ring Fractures as a Diagnostic Tool to Predict Vascular Injury Patterns and Targeted Embolization: A 10-Year Retrospective Study of Patients at a Single Regional Trauma Center in South Korea
Dae Hee Lee, Seong Wook Kim, Ki-Choul Kim
Hip & Pelvis.2025; 37(4): 321. CrossRef
Early experience with resuscitative endovascular balloon occlusion of the aorta for unstable pelvic fractures in the Republic of Korea: a multi-institutional study
Dong Hun Kim, Jonghwan Moon, Sung Wook Chang, Byung Hee Kang
European Journal of Trauma and Emergency Surgery.2023; 49(6): 2495. CrossRef

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2 Crossref

Trauma, Emergency surgery

Clinical Outcomes of Emergent Laparotomies in Hypotensive Patients: 9-years Experience at a Single Level 1 Trauma Center: Jaeri Yoo, Byung Hee Kang; J Acute Care Surg 2021;11(3):108-113. Published online November 23, 2021; DOI: https://doi.org/10.17479/jacs.2021.11.3.108

Abstract
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Purpose
The prognosis of an emergent laparotomy in hypotensive patients is poor. This study aimed to review the outcomes of hypotensive patients who had emergent laparotomies and elucidate the risk factors of mortality.
Methods
Patients who underwent an emergent laparotomy from January 2011 to December 2019 were retrospectively reviewed. The exclusion criteria included initial systolic blood pressure > 90 mmHg, aged < 19 years, and cardiac arrest before the laparotomy. Patients were categorized into survival groups (survived or deceased). Univariate and multivariate analyses were conducted to determine the risk factors of mortality. The time from the laparotomy to death was also reviewed and the effect of organ injury.
Results
There were 151 patient records, analyzed 106 survivors, and 45 deceased. The overall mortality was 29.8%. Liver injury was the main organ-related event leading to an emergent laparotomy, and most patients died in the early phase following the laparotomy. Following multivariate analysis, the Glasgow Coma Scale score [odds ratio (95% confidential interval) 0.733 (0.586-0.917), p = 0.007], total red blood cell transfusion volume in 24 hours[1.111 (1.049-1.176), p < 0.001], major bleed from the liver [3.931 (1.203-12.850), p = 0.023], and blood lactate [1.173 (1.009-1.362), p = 0.037] were identified as risk factors for mortality.
Conclusion
Glasgow Coma Scale score, total red blood cell transfusion volume in 24 hours, major bleed from the liver, and lactate were identified as risk factors for mortality. Initial resuscitation and management of liver injuries have major importance following trauma.

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Effects of prior antiplatelet and/or nonsteroidal anti-inflammatory drug use on mortality in patients undergoing abdominal surgery for abdominal sepsis
Se Hun Kim, Ki Hoon Kim
Surgery.2023; 174(3): 611. CrossRef

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1 Crossref

Critical care

Retrosternal Hemorrhage after Cardiac Compression: Byung Hee Kang, Jonghwan Moon, Kyoungwon Jung, Yo Huh; J Acute Care Surg 2018;8(1):40-41. Published online April 30, 2018; DOI: https://doi.org/10.17479/jacs.2018.8.1.40

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Fluid/Hemodymics, Trauma

Safety and Efficacy of Type-O Packed Red Blood Cell Transfusion in Traumatic Hemorrhagic Shock Patients: Preliminary Study: Byung Hee Kang, Kyoungwon Jung, Yunjung Heo, John Cook-Jong Lee; J Acute Care Surg 2017;7(2):50-55. Published online October 30, 2017; DOI: https://doi.org/10.17479/jacs.2017.7.2.50

Abstract
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Purpose:

A new unmatched type-O packed red blood cell (UORBC) storage system was established in Ajou University Hospital Trauma Center. This system was expected to deliver faster and more efficient transfusion.

Methods:

On March 2016, a new blood storage bank was installed in the trauma bay. Sixty patients who received UORBC from March 2016 to August 2016 were compared with 50 traumatic shock patients who received transfusions at the trauma bay in 2015. Time of transfusion, mortality, adverse transfusion reaction and change of systolic blood pressure were reviewed.

Results:

Transfusion time from arrival at the hospital was significantly shorter in 2016 (14.07±11.14 min vs. 34.72±15.17 min, p<0.001), but 24-hour mortality was not significantly different (13.3% vs. 20.8%, p=0.292). Systolic blood pressure significantly increased after UORBC transfusion (92.49 mmHg to 107.15 mmHg, p=0.002). Of the 60 patients who received UORBC in trauma bay, 47 (78.3%) patients had an incompatible ABO type, but no adverse transfusion reaction was notated.

Conclusion:

UORBC allows early blood transfusion and improved systolic blood pressure without significant adverse reactions.

Citations

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Preventable Death Rate of Trauma Patients in a Non-Regional Trauma Center
Kwanhoon Park, Wooram Choi, Sungho Lee, Kang Yoon Lee, Dongbeen Choi, Han-Gil Yoon, Ji Young Jang
Journal of Acute Care Surgery.2023; 13(3): 118. CrossRef
Safety of Red Blood Cell Transfusion by the Emergency Blood Transfusion Protocol
Kiwook Jung, Jikyo Lee, Ji-Sang Kang, M.T., Jae Hyeon Park, Yousun Chung, Dae-Hyun Ko, Hyungsuk Kim, Kyou-Sup Han
The Korean Journal of Blood Transfusion.2021; 32(3): 163. CrossRef
Efficacy of Uncross-Matched Type O Packed Red Blood Cell Transfusion to Traumatic Shock Patients: a Propensity Score Match Study
Byung Hee Kang, Donghwan Choi, Jayun Cho, Junsik Kwon, Yo Huh, Jonghwan Moon, Younghwan Kim, Kyoungwon Jung, John-Cook Jong Lee
Journal of Korean Medical Science.2017; 32(12): 2058. CrossRef

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Trauma, Others

Pneumoperitoneum from Subcutaneous Emphysema after Blunt Chest Injury: Byung Hee Kang, Jonghwan Moon; J Acute Care Surg 2017;7(1):30-33. Published online April 30, 2017; DOI: https://doi.org/10.17479/jacs.2017.7.1.30

Abstract
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Pneumothorax and pneumomediastinum can cause pneumoperitoneum, which does not require surgery. There are unverified theories pertaining to how air passes through the diaphragm. We report a case of pneumoperitoneum caused by blunt chest injury that was successfully managed with conservative care. Although the pneumoperitoneum was caused by thoracic injury, we believe that the air did not pass through the diaphragm, but instead came from the abdominal wall, as in subcutaneous emphysema