• Active bleeding
• Injury pattern
• Liver resection
• Nonoperative management
• Subsequent complications

• Blunt splenic injury
• Contrast extravasation
• Pseudoaneurysm
• Splenic artery embolization
• Splenic salvage rate

The damage control approach is known to reduce the mortality rate in severely injured patients and has now become a common practice. Transcatheter arterial embolization (TAE) has been shown to be useful with combining with damage control laparotomy in identifying and controlling active arterial hemorrhage. Hybrid operating room (OR) allows both damaged control surgery and TAE in the same location in minimal time. We report a case of a patient with three cardiac arrests who was saved by early intervention using damage control surgery (DCS) with interventional radiology (IVR) in the hybrid OR.

A 46-year-old woman was injured in a collision with a tree while snowboarding. She was eventually transported to hybrid operating room in our hospital with the diagnosis of significant liver laceration and hemorrhagic shock. Damage control surgery was performed with perihepatic packing (PHP) and TAE was conducted to stop active bleeding from right hepatic artery. She experienced 3 times of cardiopulmonary arrest, which was successfully resuscitated on each occasion. Although she had total of 3 times of laparotomy but tolerated well. She was discharged on day 82 of hospitalization and showed no neurological sequelae.

Saving the life of a patient with severe trauma requires a multidisciplinary approach with cooperation and early information sharing among trauma team members. Sharing treatment strategy with the trauma team and early intervention using DCS with IVR in the hybrid operating room could save the patient’s life.

• Blunt hepatic injury
• Damage control surgery
• Hybrid operating room
• Interventional radiology
• Traumatic cardiac arrest

This study investigated the risk factors for in-hospital mortality of severe blunt trauma patients who underwent transcatheter arterial embolization (TAE). We analysed data from the Japan Trauma Data Bank from 2009 to 2018. Patients with severe blunt trauma and an Injury Severity Score (ISS) ≥ 16 who underwent TAE were enrolled. The primary analysis evaluated patient characteristics and outcomes, and variables with significant differences were included in the secondary multivariate logistic regression analysis. In total, 5800 patients (6.4%) with ISS ≥ 16 underwent TAE. There were significant differences in the proportion of male patients, transportation method, injury mechanism, injury region, Revised Trauma Score, survival probability values, and those who underwent urgent blood transfusion and additional urgent surgery. In multivariable regression analyses, higher age, urgent blood transfusion, and initial urgent surgery were significantly associated with higher in-hospital mortality risk [p < 0.001, odds ratio (OR), 95% confidence interval (CI): 1.01 (1.00–1.01); p < 0.001, 3.50 (2.55–4.79); and p = 0.001, 1.36 (1.13–1.63), respectively]. Inter-hospital transfer was significantly associated with lower in-hospital mortality risk (p < 0.001, OR = 0.56, 95% CI = 0.44–0.71). Treatment protocols for urgent intervention before and after TAE and a safe, rapid inter-hospital transport system are needed to improve mortality risks for severe blunt trauma patients.

• age-related differences
• blunt trauma
• haemodynamic stabilization
• in-hospital mortality
• inter-hospital transfer
• transcatheter arterial embolization

• Damage control strategy
• Interventional radiology
• Severe trauma management
• Trauma specialist

Interventional radiology (IR) has become an integral part in the management of traumatic injuries. There is an ever-increasing role of IR in traumatic injuries of solid abdominal organs, pelvic and peripheral arteries to control active bleeding by therapeutic embolization or vascular reconstruction using stent grafts. Traditionally, these endovascular treatments have been offered to hemodynamically stable patients. However, in recent times endovascular approach has become preferable to surgery even in hemodynamically unstable patients with injury of surgically difficult-to-access sites. With shifting trends towards non operative management coupled with availability of the current state-of-the-art equipments, hardware and technical expertise, IR has gained an impeccable role in trauma management. However, due to lack of awareness and widespread acceptance, IR continues to remain an ocean of unexplored potentialities.

• Blunt abdominal trauma
• Pelvic trauma
• Peripheral arterial injury
• Interventional radiology
• Embolization

• Blunt hepatic injury
• Children
• Damage control surgery
• Delayed hepatic resection
• Transarterial embolization

• Angiography
• Gastric cancer
• Hemostasis
• Lymphadenectomy
• Postoperative arterial bleeding
• Radical gastrectomy
• Re-laparotomy

• Emergency surgery
• IVR
• Intraoperative
• Trauma
• hybrid

We present a series of patients with blunt abdominal trauma who underwent damage control laparotomy (DCL) and introduce a nomogram that we created to predict survival among these patients.

This was a retrospective study. From January 2002 to June 2012, 91 patients underwent DCL for hemorrhagic shock. We excluded patients with the following characteristics: a penetrating abdominal injury, age younger than 18 or older than 65 years, a severe or life-threatening brain injury (Abbreviated Injury Scale [AIS] ≥ 4), emergency department (ED) arrival more than 6 hours after injury, pregnancy, end-stage renal disease, or cirrhosis. In addition, we excluded patients who underwent DCL after ICU admission or later in the course of hospitalization.

The overall mortality rate was 61.5%: 35 patients survived and 56 died. We identified independent survival predictors, which included a preoperative Glasgow Coma Scale (GCS) score < 8 and a base excess (BE) value < -13.9 mEq/L. We created a nomogram for outcome prediction that included four variables: preoperative GCS, initial BE, preoperative diastolic pressure, and preoperative cardiopulmonary cerebral resuscitation (CPCR).

DCL is a life-saving procedure performed in critical patients, and devastating clinical outcomes can be expected under such dire circumstances as blunt abdominal trauma with exsanguination. The nomogram presented here may provide ED physicians and trauma surgeons with a tool for early stratification and risk evaluation in critical, exsanguinating patients.

• Blunt major liver injuries
• Damage control laparotomy
• Damage control resuscitation
• Injury severity score
• Perihepatic packing
• Transarterial embolization

• Abdominal Injuries/diagnosis
• Abdominal Injuries/mortality
• Abdominal Injuries/surgery
• Accidents, Traffic/mortality
• Adolescent
• Adult
• Aged
• Bandages
• Child
• Child, Preschool
• Combined Modality Therapy
• Embolization, Therapeutic
• Female
• Hospital Mortality
• Humans
• Injury Severity Score
• Laparotomy
• Liver/injuries
• Liver/pathology
• Male
• Middle Aged
• Multiple Trauma/diagnosis
• Multiple Trauma/mortality
• Multiple Trauma/surgery
• Prognosis
• Resuscitation
• Retrospective Studies
• Risk Factors
• Survival Analysis
• Taiwan/epidemiology
• Trauma Centers
• Treatment Outcome
• Violence/statistics & numerical data
• Wounds, Nonpenetrating/diagnosis
• Wounds, Nonpenetrating/mortality
• Wounds, Nonpenetrating/surgery