LAUSR

Learning Objectives: The hybrid ER system (HERS) is an emerging modality which is equipped with a fluoroscopy and a computed tomography (CT) scanner in an emergency room (ER) with the operating room (OR) set-up. In the HERS, surgeons and interventional radiologists can perform laparotomy, resuscitative endovascular balloon occlusion of aorta (REBOA), and transcatheter arterial embolization (TAE) simultaneously. We conducted this study to review the perioperative outcomes of laparotomies for blunt abdominal trauma patients in the HERS. Methods: Patients who underwent laparotomy for blunt abdominal trauma at our institution (4/2013 – 6/2018) were reviewed. Patients’ demographics, the location of operation (OR vs ER vs HERS), the injury severity score (ISS), the probability of survival by the TRISS method (TRISS Ps), time from arrival to operation, the frequencies of simultaneous TAE and REBOA, and the inhospital mortality were analyzed. These data were compared with patients who underwent surgery in the OR, in the ER and in the HERS. Results: During the study period, 53 patients who met the inclusion criteria were identified. There were 17 patients who underwent surgery in the OR (Group 1), 29 patients in the ER (Group 2), and 7 patients in the HERS (Group 3). Group 3 patients were most frequently in shock (systolic blood pressure [SBP] < 90mmHg) preoperatively (Group 1 vs 2 vs 3: 5 [29%] vs 15 [52%] vs 6 [86%], p=0.04). CT scans were performed most frequently in Group 3 (12 [71%] vs 14 [48%] vs 6 [86%], p=0.11) with the lowest SBP (122 ± 38 mmHg vs 98 ± 27 mmHg vs 77 ± 20 mmHg, p=0.02). Time from arrival to operation were the shortest in Group 3 (230 ± 191 minutes vs 107 ± 159 minutes vs 56 ± 30 minutes, p=0.02). Simultaneous TAEs and REBOAs were most frequently performed in Group 3 (TAEs: 2 [12%] vs 2 [7%] vs 3 [43%], p=0.04. REBOAs: 0 vs 7 [24%] vs 4 [57%], p<0.01). Mortality rates were 0 in Group 1, 59% in Group 2, and 43% in Group 3 (p<0.01). Survivors in Group 3 had the highest ISS and the lowest TRISS Ps among three groups (ISS: 17 ± 12 vs. 33 ± 10 vs. 50 ± 9, p<0.01. TRISS Ps: 92 ± 15% vs. 75 ± 39% vs. 25 ± 13%, p<0.01). Conclusions: The HERS is the potential modality to salvage patients with severe blunt abdominal trauma by allowing surgeons and interventional radiologists to perform laparotomy and REBOAs and/or TAEs simultaneously in a timely fashion in one place. Further study is warranted to establish the standardized protocol for the trauma patients care in the HERS.