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.

Citations

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Deep learning-based survival outcomes of REBOA vs resuscitative thoracotomy in trauma: a nationwide cohort study in South Korea
Jayun Cho, Jiyeon Oh, Soeun Kim, Jaehyeong Cho, Dong Keon Yon, Wu Seong Kang
International Journal of Surgery.2026;[Epub] CrossRef
Challenges and learning curve in adopting resuscitative endovascular balloon occlusion of the aorta for trauma patients: A retrospective multicenter study
Kyounghwan Kim, Byung Hee Kang, Dong Hun Kim, Byungchul Yu, Sung Wook Chang, Pil Young Jung, Yoonjung Heo, Wu Seong Kang
Injury.2026; : 113304. CrossRef

4,860 View
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Trauma, Basic

Tranexamic Acid in Trauma Management: A Review of Evidence: Namryeol Kim; J Acute Care Surg 2023;13(3):85-94. Published online November 23, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.3.85

Abstract
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Hemorrhage is the leading cause of death in trauma patients and trauma induced coagulopathy (TIC) is a major contributor to bleeding mortality. TIC has a diverse pathophysiology triggered by injury and hypoperfusion, including platelet dysfunction, endotheliopathy, fibrinogen or thrombin abnormalities, and dysregulated fibrinolysis. Early fluid resuscitation, appropriate blood transfusion, and definitive control of bleeding are essential components of initial management for TIC. Additionally, tranexamic acid (TXA), an antifibrinolytic agent, has emerged as a potential adjunctive therapy following the 2010 landmark trial that demonstrated the benefit of early administration of TXA in reducing trauma patient mortality (CRASH-2). This review provides an analysis of the current literature on the use of TXA in trauma patients. It critically evaluates the evidence on the effect of TXA on TIC and other clinical outcomes, emphasizing the time-sensitive nature of TXA administration and the variation of its effect depending on the severity and location of injury. It also discusses the optimal dosage, timing, and safety of TXA, as well as the challenges and limitations of existing studies. Furthermore, it highlights the importance of individualized treatment approaches based on the fibrinolysis status of TIC and the value of goal-directed therapy guided by viscoelastic hemostatic assays for the appropriate use of TXA.

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Pharmacokinetics of Tranexamic Acid (TXA) Delivered by Expeditious Routes in a Swine Model of Polytrauma and Hemorrhagic Shock
Mallori Wilson, Sean Stuart, Brittany Lassiter, Timothy Parker, Clyde Martin, Robert Healy, Christopher Treager, Eric Sulava, Lorie Gower, Pravina Fernandez, Emily Friedrich
Prehospital Emergency Care.2024; 28(5): 680. CrossRef

9,147 View
159 Download
1 Crossref

Shock, Basic

Pathophysiology of Hemorrhagic Shock: Wu Seong Kang, Ji Woong Yeom, Young Goun Jo, Jung Chul Kim; J Acute Care Surg 2016;6(1):2-6. Published online April 30, 2016; DOI: https://doi.org/10.17479/jacs.2016.6.1.2

Abstract
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Hemorrhage is a major cause of death in trauma patients. The medical definition of hemorrhagic shock is tissue hypoperfusion resulting from a reduction of blood volume. Decreased blood pressure resulting from acute blood loss induces cardiac stimulation, systemic vasoconstriction, and volume redistribution. These effects are due to the baroreceptor reflex, the humoral compensatory mechanisms including the renin angiotensin system, and the release of catecholamine and vasopressin. Hemorrhagic shock causes acidosis, hypothermia, and coagulopathy, known as ‘the lethal triad.’ Tissue hypoxia induces metabolic acidosis by producing lactic acid. The three components of the lethal triad amplify each other and form a vicious cycle, eventually causing the death of the patient. To reduce the risk of mortality in severely bleeding patients, we need to understand the pathophysiology of hemorrhagic shock and the related complications.

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INVESTIGATION OF THE EFFECTIVENESS OF MAGNESIUM SULFATE USE IN THE COMPOSITION OF FLUID RESUSCITATION FOR THE PREVENTION OF CELLULAR MEMBRANE DAMAGE IN PATIENTS SUFFERING FROM POLYTRAUMA UNDER CONDITIONS OF HYPOVOLEMIC TRAUMATIC SHOCK AND ISCHEMIA
O. V. Biletskiy, M. A. Stupnitskiy
Bulletin of Problems Biology and Medicine.2019; 1(2): 120. CrossRef