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Article ; Online: Impact of resuscitative endovascular balloon occlusion of the aorta on gastrointestinal function with a matched cohort study.

Matsumoto, Shokei / Aoki, Makoto / Funabiki, Tomohiro / Shimizu, Masayuki

Trauma surgery & acute care open

2024 Volume 9, Issue 1, Page(s) e001239

Abstract: Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) can temporarily control arterial hemorrhage in torso trauma; however, the abdominal visceral blood flow is also blocked by REBOA. The aim of this study was to evaluate the ... ...

Abstract	Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) can temporarily control arterial hemorrhage in torso trauma; however, the abdominal visceral blood flow is also blocked by REBOA. The aim of this study was to evaluate the influence of REBOA on gastrointestinal function. Methods: A retrospective review identified all trauma patients admitted to our trauma center between 2008 and 2019. We used propensity score matching analysis to compare the gastrointestinal function between subjects who underwent REBOA and those who did not. Data on demographics, feeding intolerance (FI), time to feeding goal achievement, and complications were retrieved. Results: During the study period, 55 patients underwent REBOA. A total of 1694 patients met the inclusion criteria, 27 of whom were a subset of those who underwent REBOA. After 1:1 propensity score matching, the REBOA and no-REBOA groups were assigned 22 patients each. Patients in the REBOA group had a significantly higher incidence of FI (77% vs. 27%; OR, 9.1; 95% CI, 2.31 to 35.7; p=0.002) and longer time to feeding goal achievement (8 vs. 6 days, p=0.022) than patients in the no-REBOA group. Patients in the REBOA group also showed significantly prolonged durations of ventilator use (8 vs. 4 days, p=0.023). Furthermore, there was no difference in the mortality rate between the groups (9% vs. 9%, p=1.000). Conclusions: REBOA was associated with gastrointestinal dysfunction. Our study findings can be useful in providing guidance on managing nutrition in trauma patients who undergo REBOA. Level of evidence: Level IV. Study type: Care management.
Language	English
Publishing date	2024-01-30
Publishing country	England
Document type	Journal Article
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2023-001239
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Article ; Online: Immediate CT after hospital arrival and decreased in-hospital mortality in severely injured trauma patients.

Yamamoto, Ryo / Suzuki, Masaru / Funabiki, Tomohiro / Sasaki, Junichi

BJS open

2023 Volume 7, Issue 1

Abstract: Background: Immediate whole-body CT (about 10 min after arrival) in an all-in-one resuscitation room equipped with CT has been found to be associated with shorter time to haemostasis and lower in-hospital mortality. The aim of this study was to ... ...

Abstract	Background: Immediate whole-body CT (about 10 min after arrival) in an all-in-one resuscitation room equipped with CT has been found to be associated with shorter time to haemostasis and lower in-hospital mortality. The aim of this study was to elucidate the benefits of immediate whole-body CT after hospital arrival in patients with severe trauma with the hypothesis that immediate CT within 10 min is associated with lower in-hospital mortality. Method: This retrospective cohort study of patients with an injury severity score of more than 15 who underwent whole-body CT was conducted using the Japanese Trauma Databank (2019-2020). An immediate CT was conducted within 10 min after arrival. In-hospital mortality, frequency of subsequent surgery, and time to surgery were compared with immediate and non-immediate CT. Inverse probability weighting was conducted to adjust for patient backgrounds, including mechanism and severity of injury, prehospital treatment, vital signs, and institutional characteristics. Results: Among the 7832 patients included, 646 underwent immediate CT. Immediate CT was associated with lower in-hospital mortality (12.5 versus 15.7 per cent; adjusted OR 0.77 (95 per cent c.i. 0.69 to 0.84); P < 0.001) and fewer damage-control surgeries (OR 0.75 (95 per cent c.i. 0.65 to 0.87)). There was a 10 to 20 min difference in median time to craniotomy, laparotomy, and angiography. These benefits were observed regardless of haemodynamic instability on hospital arrival, while they were identified only in elderly patients with severe injury and altered consciousness. Conclusion: Immediate CT within 10 min after arrival was associated with decreased in-hospital mortality in severely injured trauma patients.
MeSH term(s)	Humans ; Aged ; Retrospective Studies ; Hospital Mortality ; Tomography, X-Ray Computed ; Angiography ; Hospitals
Language	English
Publishing date	2023-01-04
Publishing country	England
Document type	Journal Article
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1093/bjsopen/zrac133
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Article: A clinical prediction model for non-operative management failure in patients with high-grade blunt splenic injury.

Matsumoto, Shokei / Aoki, Makoto / Shimizu, Masayuki / Funabiki, Tomohiro

Heliyon

2023 Volume 9, Issue 10, Page(s) e20537

Abstract: Background: Nonoperative management (NOM) is the standard treatment for hemodynamically stable blunt splenic injury (BSI). However, NOM failure is a significant source of morbidity and mortality. We developed a clinical risk scoring system for NOM ... ...

Abstract	Background: Nonoperative management (NOM) is the standard treatment for hemodynamically stable blunt splenic injury (BSI). However, NOM failure is a significant source of morbidity and mortality. We developed a clinical risk scoring system for NOM failure in BSI. Methods: Data from the Japanese Trauma Data Bank from 2008 to 2018 were analyzed. Eligible patients were restricted to those who underwent NOM with high-grade BSI (Organ Injury Scale ≥3). The primary outcome was a predictive score for NOM failure based on risk estimation. Results: There were 1651 patients included in this analysis, among whom 110 (6.7%) patients had NOM failure. Multivariate analysis identified seven variables associated with failed NOM: systolic blood pressure, Glasgow coma scale, Injury Severity Score, other concomitant abdominal injury, pelvic injury, high-grade BSI, and angioembolization. An eight-point predictive score was developed with a cut-off of greater than 5 points (specificity, 98.2%; sensitivity, 25.5%) with an area under the curve of 0.81. Conclusion: The clinical predictive score had good ability to predict NOM failure and may help surgeons to make better decisions for BSI.
Language	English
Publishing date	2023-09-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2023.e20537
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Article ; Online: Immediate Angiography and Decreased In-Hospital Mortality of Adult Trauma Patients: A Nationwide Study.

Yamamoto, Ryo / Maeshima, Katsuya / Funabiki, Tomohiro / Eastridge, Brian J / Cestero, Ramon F / Sasaki, Junichi

Cardiovascular and interventional radiology

2024 Volume 47, Issue 4, Page(s) 472–480

Abstract: Purpose: This study aimed to elucidate whether immediate angiography within 30 min is associated with lower in-hospital mortality compared with non-immediate angiography.: Materials and methods: We conducted a retrospective cohort study using a ... ...

Abstract	Purpose: This study aimed to elucidate whether immediate angiography within 30 min is associated with lower in-hospital mortality compared with non-immediate angiography. Materials and methods: We conducted a retrospective cohort study using a nationwide trauma databank (2019-2020). Adult trauma patients who underwent emergency angiography within 12 h after hospital arrival were included. Patients who underwent surgery before angiography were excluded. Immediate angiography was defined as one performed within 30 min after arrival (door-to-angio time ≤ 30 min). In-hospital mortality and non-operative management (NOM) failure were compared between patients with immediate and non-immediate angiography. Inverse probability weighting with propensity scores was conducted to adjust patient demographics, injury mechanism and severity, vital signs on hospital arrival, and resuscitative procedures. A restricted cubic spline curve was drawn to reveal survival benefits by door-to-angio time. Results: Among 1,455 patients eligible for this study, 92 underwent immediate angiography. Angiography ≤ 30 min was associated with decreased in-hospital mortality (5.0% vs 11.1%; adjusted odds ratio [OR], 0.42 [95% CI, 0.31-0.56]; p < 0.001), as well as lower frequency of NOM failure: thoracotomy and laparotomy after angiography (0.8% vs. 1.8%; OR, 0.44 [0.22-0.89] and 2.6% vs. 6.5%; OR, 0.38 [0.26-0.56], respectively). The spline curve showed a linear association between increasing mortality and prolonged door-to-angio time in the initial 100 min after arrival. Conclusion: In trauma patients, immediate angiography ≤ 30 min was associated with lower in-hospital mortality and fewer NOM failures. Level of evidence: Level 3b, non randomized controlled cohort/follow up study.
MeSH term(s)	Adult ; Humans ; Hospital Mortality ; Retrospective Studies ; Follow-Up Studies ; Cohort Studies ; Angiography
Language	English
Publishing date	2024-02-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	603082-8
ISSN	1432-086X ; 0342-7196 ; 0174-1551
ISSN (online)	1432-086X
ISSN	0342-7196 ; 0174-1551
DOI	10.1007/s00270-024-03664-6
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Article ; Online: Blunt Splenic Injury and Prophylactic Splenic Artery Embolization.

Aoki, Makoto / Matsumoto, Shokei / Funabiki, Tomohiro

JAMA surgery

2021

Language	English
Publishing date	2021-04-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2021.0625
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Article ; Online: Arterial Embolisation for Trauma Patients with Pelvic Fractures in Emergency Settings: A Nationwide Matched Cohort Study in Japan.

Furugori, Shintaro / Abe, Takeru / Funabiki, Tomohiro / Sekikawa, Zenjiro / Takeuchi, Ichiro

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

2022 Volume 64, Issue 2-3, Page(s) 234–242

Abstract: Objective: The objective of this study was to determine the association between arterial embolisation (AE) for pelvic fractures and death.: Methods: The study had a retrospective design, using data from a nationwide population based prospective ... ...

Abstract	Objective: The objective of this study was to determine the association between arterial embolisation (AE) for pelvic fractures and death. Methods: The study had a retrospective design, using data from a nationwide population based prospective registry of trauma patients in Japan. This propensity score matched study included all adult patients from the registry with pelvic fractures between January 2004 and December 2018. The primary outcome was hospital death. Secondary outcomes included 28 day survival and length of hospital stay (LOS) in days. Multivariable logistic regression analyses were performed to control confounding variables, including patient, clinical, and hospital related variables; concomitant trauma; severe trauma; and haemodynamic instability. A conditional logistic regression analysis was performed to assess the association between treatment of pelvic fracture with AE and hospital mortality rate. Results: Among 17 670 eligible patients with pelvic fractures, 2 379 (13.5%) underwent AE (AE group) and 1 512 (8.6%) died in the hospital. After one to one propensity matching with 2 138 patients from each group (AE and non-AE), the hospital mortality rate was significantly lower in the AE group than in the non-AE group (15.0% vs. 18.1%; p = .007). The AE group had significantly lower mortality (odds ratio; 95% confidence interval [CI] 0.60; 0.43 - 0.84; p = .003) and a significantly higher 28 day mean survival rate than the non-AE group (0.89; 95% CI 0.87 - 0.90 vs. 0.86; 0.85 - 0.88; p = .003), although there was no significant difference in the LOS (48 days vs. 46 days; p = .11). Conclusion: This propensity score matched analysis showed an association between AE for pelvic fractures and lower hospital mortality rates. The findings in this large nationwide cohort study provide strong evidence for the benefit of embolisation for patients with pelvic fractures.
MeSH term(s)	Adult ; Humans ; Cohort Studies ; Retrospective Studies ; Japan/epidemiology ; Pelvic Bones/injuries ; Fractures, Bone/therapy ; Fractures, Bone/complications
Language	English
Publishing date	2022-06-13
Publishing country	England
Document type	Journal Article
ZDB-ID	1225869-6
ISSN	1532-2165 ; 1078-5884
ISSN (online)	1532-2165
ISSN	1078-5884
DOI	10.1016/j.ejvs.2022.05.048
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Article ; Online: Near-fatal negative pressure pulmonary oedema successfully treated with venovenous extracorporeal membrane oxygenation performed in the hybrid emergency room.

Matsumura, Kazuki / Toyoda, Yukitoshi / Matsumoto, Shokei / Funabiki, Tomohiro

BMJ case reports

2020 Volume 13, Issue 9

Abstract: We report a rare case of negative pressure pulmonary oedema (NPPE), a life-threatening complication of tracheal intubation. A 41-year-old obese man was admitted to a previous hospital for neck surgery. After extubation, he developed respiratory distress ... ...

Abstract	We report a rare case of negative pressure pulmonary oedema (NPPE), a life-threatening complication of tracheal intubation. A 41-year-old obese man was admitted to a previous hospital for neck surgery. After extubation, he developed respiratory distress followed by haemoptysis and desaturation. The patient was reintubated and brought to our hospital where we introduced venovenous extracorporeal membrane oxygenation (ECMO) to prevent cardiac arrest, which is an unusual clinical course for NPPE. He returned to his routine without any sequelae. This is the first case report of NPPE successfully resolved with venovenous ECMO in the hybrid emergency room (hybrid ER), which is a resuscitation room equipped with interventional radiology features and a sliding CT scanner. Since the hybrid ER serves as a single move for patients where all necessary procedures are performed, it has the potential to lower the incidence of cannulation complications, beyond the delay in ECMO initiation.
MeSH term(s)	Adult ; Airway Extubation/adverse effects ; Airway Extubation/methods ; Extracorporeal Membrane Oxygenation/methods ; Heart Arrest/etiology ; Heart Arrest/prevention & control ; Hemoptysis/diagnosis ; Hemoptysis/etiology ; Humans ; Male ; Pulmonary Edema/diagnosis ; Pulmonary Edema/etiology ; Pulmonary Edema/therapy ; Respiration, Artificial/adverse effects ; Respiration, Artificial/instrumentation ; Respiration, Artificial/methods ; Respiratory Insufficiency/diagnosis ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/physiopathology ; Treatment Outcome ; Ventilators, Negative-Pressure
Language	English
Publishing date	2020-09-09
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2020-234651
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Article ; Online: Difference in postcourse knowledge and confidence between Web-based and on-site training courses on resuscitative endovascular balloon occlusion of the aorta.

Funakoshi, Hiraku / Matsumura, Yosuke / Maruhashi, Takaaki / Ishida, Kenichiro / Funabiki, Tomohiro

Acute medicine & surgery

2021 Volume 8, Issue 1, Page(s) e707

Abstract: Aim: Effective courses are essential for highly invasive procedures such as resuscitative endovascular balloon occlusion of the aorta. However, the coronavirus disease pandemic has forced the postponement of on-site educational courses due to ... ...

Abstract	Aim: Effective courses are essential for highly invasive procedures such as resuscitative endovascular balloon occlusion of the aorta. However, the coronavirus disease pandemic has forced the postponement of on-site educational courses due to transmission concerns. Few studies have examined the effectiveness of Web-based education in highly invasive procedures. To address this knowledge gap, this study aimed to investigate whether knowledge acquisition and confidence after the Web-based course are different from those acquired after the on-site course, using pre- and postcourse test scores. Methods: The increase in scores before and after the course was compared between the on-site and Web-based courses. The questions reflected knowledge about seven different topics in the course modules. In addition, participants were asked about their self-rated confidence about three topics before and after the course. Results: Thirty learners completed the on-site course, and 21 learners completed the Web-based course. Forty-seven learners completed both the precourse and postcourse tests. In both courses, the difference between the precourse and postcourse test scores showed a statistically significant increase in knowledge (on-site course: increased score, 1.8; 95% confidence interval, 0.8 to 2.8; Web-based course: increased score, 1.6, 95% confidence interval, 0.5 to 2.5). However, the difference was not statistically significant in the self-rated confidence scores about "sheath and catheter removal" among learners of the Web-based course. Conclusion: Knowledge increased significantly in both the on-site and Web-based courses. However, the Web-based course might not be sufficient to give learners confidence in the procedures.
Language	English
Publishing date	2021-11-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2751184-4
ISSN	2052-8817 ; 2052-8817
ISSN (online)	2052-8817
ISSN	2052-8817
DOI	10.1002/ams2.707
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Article: Hybrid emergency room management of a ruptured abdominal aortic aneurysm.

Murai, Yuta / Matsumoto, Shokei / Egawa, Tomohisa / Funabiki, Tomohiro / Shimogawara, Tatsuya

Journal of vascular surgery cases and innovative techniques

2020 Volume 7, Issue 1, Page(s) 21–25

Abstract: Patients with a ruptured abdominal aortic aneurysm (rAAA) still have high mortality. Rapid diagnosis and treatment are vital for improving survival outcomes. rAAA management has evolved regarding these factors. We have reported the case of a 70-year-old ... ...

Abstract	Patients with a ruptured abdominal aortic aneurysm (rAAA) still have high mortality. Rapid diagnosis and treatment are vital for improving survival outcomes. rAAA management has evolved regarding these factors. We have reported the case of a 70-year-old man with an rAAA that was rapidly diagnosed and treated in a hybrid emergency room (ER). A hybrid ER is an integrated ER capable of computed tomography scanning, interventional radiology, and surgery in one place. In the present case, the door-to-intervention time was 35 minutes. The use of hybrid ERs has the potential to enhance the speed and quality of diagnostic and definitive treatment of rAAAs.
Language	English
Publishing date	2020-12-28
Publishing country	United States
Document type	Case Reports
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2020.12.006
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Article: Rupture of Hepatocellular Carcinoma after Transarterial Chemoembolization followed by Massive Gastric Bleeding.

Nishida, Kazuhiro / Lefor, Alan Kawarai / Funabiki, Tomohiro

Case reports in hepatology

2018 Volume 2018, Page(s) 4576276

Abstract: Introduction: Transarterial chemoembolization (TACE) is the first-line therapy for patient with unresectable hepatocellular carcinoma (HCC). Although TACE is a generally safe procedure, major complications can be occurred. We describe a patient with ... ...

Abstract	Introduction: Transarterial chemoembolization (TACE) is the first-line therapy for patient with unresectable hepatocellular carcinoma (HCC). Although TACE is a generally safe procedure, major complications can be occurred. We describe a patient with rupture of HCC after TACE followed by gastric bleeding. Case presentation: An 81-year-old man presented with worsening epigastric pain. He had been diagnosed with multiple HCC with nonalcoholic steatohepatitis and underwent TACE 19 days previously. A contrast enhanced computed tomography (CT) scan of the abdomen showed rupture of an HCC. He was treated nonoperatively and discharged on hospital day 18. Five weeks after TACE, he was emergently admitted with massive hematochezia and shock. A contrast enhanced CT scan demonstrated extrinsic gastric compression by an HCC lesion with extravasation of contrast into the stomach. Emergent upper gastrointestinal endoscopy showed a bleeding gastric ulcer with extraluminal compression which was successfully controlled by hypertonic saline-epinephrine injection. Due to tumor progression, he was discharged for palliative care and died six weeks after TACE. Conclusion: Rupture of HCC is a life-threatening complication after TACE with mortality rates up to 50%. After treatment of a ruptured HCC, extragastric compression and bleeding can occur due to direct compression by a primary lesion or intraperitoneal dissemination.
Language	English
Publishing date	2018-06-04
Publishing country	United States
Document type	Case Reports
ISSN	2090-6587
ISSN	2090-6587
DOI	10.1155/2018/4576276
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