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Article ; Online: Prehospital Resuscitation: What Should It Be?

Manning, James E / Morrison, Jonathan J / Pepe, Paul E

2023 Volume 57, Issue 1, Page(s) 233–256

Abstract: Prehospital resuscitation is a dynamic field now being energized by new technologies and a shift in thinking regarding intravascular resuscitation. Growing evidence discourages use of intravenous (IV) crystalloid and colloid solutions in trauma, whereas ... ...

Abstract	Prehospital resuscitation is a dynamic field now being energized by new technologies and a shift in thinking regarding intravascular resuscitation. Growing evidence discourages use of intravenous (IV) crystalloid and colloid solutions in trauma, whereas blood products, particularly whole blood, are becoming preferred. Although randomized clinical trials validating definitive resuscitative protocols are still lacking, most preclinical and clinical indicators support this approach. In addition, emerging technologies such as external and endovascular hemorrhage control devices and extracorporeal perfusion are now being used routinely, even in the prehospital setting in many countries, generating new lines of emerging investigations for trauma specialists.
MeSH term(s)	Humans ; Hemorrhage/therapy ; Resuscitation/methods ; Perfusion ; Crystalloid Solutions ; Emergency Medical Services ; Wounds and Injuries
Chemical Substances	Crystalloid Solutions
Language	English
Publishing date	2023-06-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	411889-3
ISSN	1878-0555 ; 0065-3411
ISSN (online)	1878-0555
ISSN	0065-3411
DOI	10.1016/j.yasu.2023.04.005
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Zs.A 92: Show issues

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Article ; Online: Noncompressible Torso Hemorrhage.

Morrison, Jonathan J

Critical care clinics

2017 Volume 33, Issue 1, Page(s) 37–54

Abstract: Noncompressible torso hemorrhage (NCTH) constitutes a leading cause of potentially preventable trauma mortality. NCTH is defined by high-grade injury present in one or more of the following anatomic domains: pulmonary, solid abdominal organ, major ... ...

Abstract	Noncompressible torso hemorrhage (NCTH) constitutes a leading cause of potentially preventable trauma mortality. NCTH is defined by high-grade injury present in one or more of the following anatomic domains: pulmonary, solid abdominal organ, major vascular or pelvic trauma; plus hemodynamic instability or the need for immediate hemorrhage control. Rapid operative management, as part of a damage control resuscitation strategy, remains the mainstay of treatment. However, endovascular techniques are evolving and may become more mainstream with the advent of hybrid rooms that can deliver concurrent open and radiologic/endovascular management of traumatic hemorrhage.
MeSH term(s)	Emergency Medical Services/standards ; Endovascular Procedures ; Hemorrhage/therapy ; Humans ; Practice Guidelines as Topic ; Resuscitation ; Torso/physiopathology
Language	English
Publishing date	2017-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1006423-0
ISSN	1557-8232 ; 0749-0704
ISSN (online)	1557-8232
ISSN	0749-0704
DOI	10.1016/j.ccc.2016.09.001
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Article ; Online: Identifying temporal variations in burn admissions.

Beyene, Robel T / Stonko, David P / Gondek, Stephen P / Morrison, Jonathan J / Dennis, Bradley M

PloS one

2023 Volume 18, Issue 6, Page(s) e0286154

Abstract: Background: Variations in admission patterns have been previously identified in non-elective surgical services, but minimal data on the subject exists with respect to burn admissions. Improved understanding of the temporal pattern of burn admissions ... ...

Abstract	Background: Variations in admission patterns have been previously identified in non-elective surgical services, but minimal data on the subject exists with respect to burn admissions. Improved understanding of the temporal pattern of burn admissions could inform resource utilization and clinical staffing. We hypothesize that burn admissions have a predictable temporal distribution with regard to the time of day, day of week, and season of year in which they present. Study design: A retrospective, cohort observational study of a single burn center from 7/1/2016 to 3/31/2021 was performed on all admissions to the burn surgery service. Demographics, burn characteristics, and temporal data of burn admissions were collected. Bivariate absolute and relative frequency data was captured and plotted for all patients who met inclusion criteria. Heat-maps were created to visually represent the relative admission frequency by time of day and day of week. Frequency analysis grouped by total body surface area against time of day and relative encounters against day of year was performed. Results: 2213 burn patient encounters were analyzed, averaging 1.28 burns per day. The nadir of burn admissions was from 07:00 and 08:00, with progressive increase in the rate of admissions over the day. Admissions peaked in the 15:00 hour and then plateaued until midnight (p<0.001). There was no association between day of week in the burn admission distribution (p>0.05), though weekend admissions skewed slightly later (p = 0.025). No annual, cyclical trend in burn admissions was identified, suggesting that there is no predictable seasonality to burn admissions, though individual holidays were not assessed. Conclusion: Temporal variations in burn admissions exist, including a peak admission window late in the day. Furthermore, we did not find a predictable annual pattern to use in guiding staffing and resource allocation. This differs from findings in trauma, which identified admission peaks on the weekends and an annual cycle that peaks in spring and summer.
MeSH term(s)	Humans ; Retrospective Studies ; Patient Admission ; Hospitalization ; Cohort Studies ; Burn Units ; Length of Stay
Language	English
Publishing date	2023-06-08
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0286154
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Article ; Online: Roles of Trauma CT and CTA in Salvaging the Threatened or Mangled Extremity.

Dreizin, David / Smith, Elana B / Champ, Kathryn / Morrison, Jonathan J

Radiographics : a review publication of the Radiological Society of North America, Inc

2022 Volume 42, Issue 2, Page(s) E50–E67

Abstract: Extremity arterial injuries account for up to 50% of all arterial traumas. The speed, accuracy, reproducibility, and close proximity of modern CT scanners to the trauma bay have led to the liberal use of CT angiography (CTA) when a limb is in ischemic ... ...

Abstract	Extremity arterial injuries account for up to 50% of all arterial traumas. The speed, accuracy, reproducibility, and close proximity of modern CT scanners to the trauma bay have led to the liberal use of CT angiography (CTA) when a limb is in ischemic jeopardy or is a potential source of life-threatening hemorrhage. The radiologist plays a critical role in the rapid communication of findings related to vessel transection and occlusion. Another role of CT that is often overlooked involves adding value to surgical planning. The following are some of the key questions addressed in this review: How does CTA help determine whether a limb is salvageable? How do concurrent multisystem injuries affect decision making? Which arterial injuries can be safely managed with observation alone? What damage control techniques are used to address compartment syndrome and hemorrhage? What options are available for definitive revascularization? Ideally, the radiologist should be familiar with the widely used Gustilo-Anderson open-fracture classification system, which was developed to prognosticate the likelihood of a functional limb salvage on the basis of soft-tissue and bone loss. When functional salvage is feasible or urgent hemorrhage control is required, communication with trauma surgeon colleagues is augmented by an understanding of the unique surgical, endovascular, and hybrid approaches available for each anatomic region of the upper and lower extremities. The radiologist should also be familiar with the common postoperative appearances of staged vascular, orthopedic, and plastic reconstructions for efficient clinically relevant reporting of potential down-range complications.
MeSH term(s)	Computed Tomography Angiography ; Fractures, Open/surgery ; Humans ; Limb Salvage/methods ; Lower Extremity ; Reproducibility of Results ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-03-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603172-9
ISSN	1527-1323 ; 0271-5333
ISSN (online)	1527-1323
ISSN	0271-5333
DOI	10.1148/rg.210092
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Zs.A 1751: Show issues

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Article ; Online: Endovascular stenting techniques for blunt carotid injury.

Abdou, Hossam / Treffalls, Rebecca N / Stonko, David P / Kundi, Rishi / Morrison, Jonathan J

Vascular

2023 , Page(s) 17085381231193062

Abstract: Objectives: While methods of endovascular carotid artery stenting have improved over time, concerns surrounding the safety and efficacy of stenting for blunt carotid injury (BCI) remain. This study aims to present our approach to carotid artery stenting ...

Abstract	Objectives: While methods of endovascular carotid artery stenting have improved over time, concerns surrounding the safety and efficacy of stenting for blunt carotid injury (BCI) remain. This study aims to present our approach to carotid artery stenting (CAS) by incorporating new technologies such as flow-diverting stents and circuits. Methods: There is no robust evidence to support routine carotid artery stenting; however, there are several therapeutic options and approaches for treating BCI that currently require an individualized approach. Endovascular stenting and specific stent selection are largely dictated by the disease process the surgeon intends to treat. We will discuss patient selection, medical management, and the most common revascularization techniques, including transfemoral stenting, trans-carotid arterial revascularization using flow reversal, and stent-assisting coiling. Results: It must be stressed that endovascular intervention is not an alternative to or preclusive of antithrombotic or anticoagulant therapy. In the setting of BCI, transfemoral CAS is most appropriate in patients who are symptomatic, have a rapidly progressing or large lesion, and do not have a soft thrombus present due to risk of embolism. Unlike transfemoral CAS, TCAR offers an elegant solution for embolic protection when patients have a soft thrombus present. In the case of a large pseudoaneurysm, we perform stent-assisted coiling. Conclusions: We practice selective endovascular intervention, stenting lesions that are flow-limiting or have large or rapidly expanding pseudoaneurysms, and only in patients for whom anticoagulation and antiplatelet agents are not contraindicated. As technology and investigation progress, the concerns regarding the safety and the role of endovascular intervention in the treatment of BCI will be more clearly defined.
Language	English
Publishing date	2023-07-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2137151-9
ISSN	1708-539X ; 1708-5381
ISSN (online)	1708-539X
ISSN	1708-5381
DOI	10.1177/17085381231193062
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Zs.A 4277: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 590: Show issues

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Article ; Online: Acute management of mesenteric emergencies: Tailoring the solution to the problem.

Treffalls, Rebecca N / Stonko, David P / DeMartino, Randall R / Morrison, Jonathan J

Seminars in vascular surgery

2023 Volume 36, Issue 2, Page(s) 234–249

Abstract: Acute mesenteric ischemia (AMI) constitutes a life-threatening problem that can result in death, multiorgan failure, and severe nutritional disability. Although AMI is a rare cause of acute abdominal emergencies, ranging between 1 and 2 individuals per ... ...

Abstract	Acute mesenteric ischemia (AMI) constitutes a life-threatening problem that can result in death, multiorgan failure, and severe nutritional disability. Although AMI is a rare cause of acute abdominal emergencies, ranging between 1 and 2 individuals per 10,000, the morbidity and mortality rates are high. Arterial embolic etiology composes nearly one-half of AMIs, with a sudden onset of severe abdominal pain considered the most common symptom. Arterial thrombosis is the second most common cause of AMI, which presents similarly to arterial embolic AMI, although often more severe due to anatomic differences. Veno-occlusive causes of AMI are the third most common and are associated with an insidious onset of vague abdominal pain. Each patient is unique, and the treatment plan should be tailored to their individual needs. This may include considering the patient's age, comorbidities, and overall health, as well as their preferences and personal circumstances. A multidisciplinary approach involving specialists from different fields, such as surgeons, interventional radiologists, and intensivists, is recommended for the best possible outcome. Potential challenges in tailoring an optimal treatment plan for AMI may include delayed diagnosis, limited availability of specialized care, or patient factors that make some interventions less feasible. Addressing these challenges requires a proactive and collaborative approach, with regular review and adjustment of the treatment plan as needed to ensure the best possible outcome for each patient.
MeSH term(s)	Humans ; Emergencies ; Mesentery ; Mesenteric Ischemia/diagnostic imaging ; Mesenteric Ischemia/therapy ; Thrombosis ; Embolism/complications ; Acute Disease ; Treatment Outcome ; Retrospective Studies
Language	English
Publishing date	2023-04-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645131-7
ISSN	1558-4518 ; 0895-7967
ISSN (online)	1558-4518
ISSN	0895-7967
DOI	10.1053/j.semvascsurg.2023.04.007
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Zs.A 2503: Show issues

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Article ; Online: Raising Systemic Blood Pressure to Delay Irreversible Intestinal Ischemia in a Swine Model of Proximal Superior Mesenteric ArteryOcclusion.

Stonko, David P / Edwards, Joseph / Abdou, Hossam / Treffalls, Rebecca / Walker, Patrick / Morrison, Jonathan J

The Journal of surgical research

2023 Volume 295, Page(s) 70–80

Abstract: Introduction: Acute proximal superior mesenteric artery (SMA) occlusion is highly lethal, and adjuncts are needed to mitigate ischemic injury until definitive therapy. We hypothesized that raising mean arterial pressure (MAP) >90 mmHg with ... ...

Abstract	Introduction: Acute proximal superior mesenteric artery (SMA) occlusion is highly lethal, and adjuncts are needed to mitigate ischemic injury until definitive therapy. We hypothesized that raising mean arterial pressure (MAP) >90 mmHg with norepinephrine may delay irreversible bowel ischemia by increasing gastroduodenal artery (GDA) flow despite possible pressor-induced vasospasm. Methods: 12 anesthetized swine underwent laparotomy, GDA flow probe placement, and proximal SMA exposure and clamping. Animals were randomized between conventional therapy (CT) versus targeted MAP >90 mmHg (MAP push; MP) where norepinephrine was titrated after 45 min of SMA occlusion. Animals were followed until bowel death or 4 h. Kaplan-Meier bowel survival, mean normalized GDA flow, and histology were compared. Results: 12 swine (mean 57.8 ± 7.6 kgs) were included, six per group. Baseline weight, HR, MAP and GDA flows were not different. Within 5 min following SMA clamping, all 12 animals had an increase in MAP without other intervention from 81.7 to 105.5 mmHg (29.1%, P < 0.01) with a concomitant 74.9% increase in GDA flow as compared to baseline (P < 0.01). Beyond 45 min postclamp, MAP was greater in the MP group as intended, as were GDA flows. Median time to irreversibly ischemic bowel was 31% longer for MAP push animals (CT: 178 versus MP: 233 min, P = 0.006), Hazard Ratio of CT 8.85 (95% CI: 1.86-42.06); 3/6 MP animals versus 0/6 CT animals with bowel survived to predetermined end point. Conclusions: In this swine model of acute complete proximal SMA occlusion, increasing MAP >90 mmHg with norepinephrine was associated with an increase in macrovascular blood flow through the GDA and bowel survival. Norepinephrine was not associated with worse bowel survival and a MAP push may increase the time window where ischemic bowel can be salvaged.
MeSH term(s)	Animals ; Arterial Pressure ; Blood Pressure ; Ischemia/pathology ; Mesenteric Artery, Superior/surgery ; Mesenteric Ischemia/etiology ; Mesenteric Ischemia/surgery ; Norepinephrine ; Swine
Chemical Substances	Norepinephrine (X4W3ENH1CV)
Language	English
Publishing date	2023-11-21
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial, Veterinary
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.09.076
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Zs.A 178: Show issues

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Article ; Online: Extracorporeal Membrane Oxygenation Support During Repair of a Noniatrogenic Tracheal Injury.

Clark, Jaclyn / Morrison, Jonathan J / O'Connor, James V

The Annals of thoracic surgery

2021 Volume 113, Issue 1, Page(s) e49–e51

Abstract: Tracheal trauma is uncommon but carries major morbidity and mortality. A 26-year-old man sustained a near-transection of the cervical trachea due to penetrating trauma. Venovenous extracorporeal membrane oxygenation support allowed a controlled primary ... ...

Abstract	Tracheal trauma is uncommon but carries major morbidity and mortality. A 26-year-old man sustained a near-transection of the cervical trachea due to penetrating trauma. Venovenous extracorporeal membrane oxygenation support allowed a controlled primary repair with muscular buttress and facilitated airway management. Facial injuries prevented oral intubation, and retrograde intubation through the transection established an airway. On the 10th postoperative day a percutaneous tracheostomy was performed through the surgical site. This case discusses the management, technical details, and adjuncts to successfully repair complex tracheal injuries.
MeSH term(s)	Adult ; Extracorporeal Membrane Oxygenation ; Humans ; Intraoperative Care/methods ; Male ; Trachea/injuries ; Trachea/surgery ; Wounds, Penetrating/surgery
Language	English
Publishing date	2021-03-24
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.03.029
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Zs.A 252: Show issues

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Article ; Online: Technical and analytical approach to biventricular pressure-volume loops in swine including a completely endovascular, percutaneous closed-chest large animal model.

Stonko, David P / Rousseau, Mathieu C / Price, Colin / Benike, Amy / Treffalls, Rebecca N / Brunton, Nichole E / Rosen, Dorian / Morrison, Jonathan J

JVS-vascular science

2024 Volume 5, Page(s) 100190

Abstract: Pressure-volume (PV) loop analysis is a sophisticated invasive approach to quantifying load-dependent and independent measures of cardiac function. Biventricular (BV) PV loops allow left and right ventricular function to be quantified simultaneously and ... ...

Abstract	Pressure-volume (PV) loop analysis is a sophisticated invasive approach to quantifying load-dependent and independent measures of cardiac function. Biventricular (BV) PV loops allow left and right ventricular function to be quantified simultaneously and independently, which is important for conditions and certain physiologic states, such as ventricular decoupling or acute physiologic changes. BV PV loops can be performed in an entirely endovascular, percutaneous, and closed-chest setting. This technique is helpful in a survival animal model, as a percutaneous monitoring system during endovascular device experiments, or in cases where chest wall compliance is being tested or may be a confounder. In this article, we describe the end-to-end implementation of a completely endovascular, totally percutaneous, and closed-chest large animal model to obtain contemporaneous BV PV loops in 40 to 70 kg swine. We describe the associated surgical and technical challenges and our solutions to obtaining endovascular BV PV loops, closed-chest cardiac output, and stroke volume (including validation of the correction factor necessary for thermodilution), as well as how to perform endovascular inferior vena cava occlusion in this swine model. We also include techniques for data acquisition and analysis that are required for this method.
Language	English
Publishing date	2024-01-17
Publishing country	United States
Document type	Journal Article
ISSN	2666-3503
ISSN (online)	2666-3503
DOI	10.1016/j.jvssci.2024.100190
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Article ; Online: What's New in SHOCK, September 2018?

Morrison, Jonathan J / Scalea, Thomas M

Shock (Augusta, Ga.)

2018 Volume 50, Issue 3, Page(s) 255–257

MeSH term(s)	Animals ; Humans ; Periodicals as Topic ; Shock
Language	English
Publishing date	2018-09-04
Publishing country	United States
Document type	Editorial ; Introductory Journal Article
ZDB-ID	1185432-7
ISSN	1540-0514 ; 1073-2322
ISSN (online)	1540-0514
ISSN	1073-2322
DOI	10.1097/SHK.0000000000001186
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