Is there a role for REBOA? A system assessment.

INTRODUCTION: To analyze our experience to quantify potential need for resuscitative endovascular balloon occlusion of the aorta (REBOA). METHODS: Retrospective review of patients over a three-year period who presented as a trauma with hemorrhagic shock. Patients were divided into two groups: REBOA Candidate vs. Non-candidates. Injuries, outcomes, and interventions were compared. RESULTS: Of 7643 trauma activations, only 37 (0.44%) fit inclusion criteria, of which 16 met criteria for candidacy for potential REBOA placement. The groups did not differ in terms of injury severity, physiology, age, timing of intervention, nor massive transfusion. Survival was linked to TRISS (p = 0.01) and Emergency Room Thoracotomy (p = 0.002). Of Candidates, 8 (50%) had injuries that could have benefited from REBOA, while 7 (44%) had injuries that could be associated with potential harm. DISCUSSION: The volume of patients who would potentially benefit from REBOA appears to be small and does not appear to support system wide adoption in the studied region. LEVEL OF EVIDENCE: IV.

Use of negative pressure wound therapy with automated, volumetric instillation for the treatment of extremity and trunk wounds: clinical outcomes and potential cost-effectiveness.

OBJECTIVE: A growing body of literature supports use of negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) with positive clinical outcomes and potential cost savings. A retrospective analysis was performed to compare clinical outcomes of wounds treated with NPWTi-d versus NPWT and to estimate cost-differences between treatments based on clinical outcomes. METHODS: Data were extracted from records of patients with extremity or trunk wounds treated with NPWT (n = 34) or NPWTi-d using saline or polyhexanide (n = 48). On the basis of outcomes data, a hypothetical economic model using cost assumptions was created to calculate cost savings for NPWTi-d (related to) number of debridements and length of therapy. Operating room debridement cost was $3393 according to Granick et al. Daily therapy cost for each modality was $194.80 (NPWTi-d) and $106.08 (NPWT) based on internal company information. RESULTS: RESULTS showed significant differences (P < 0.0001) between NPWTi-d and NPWT patients, respectively, for the following: mean operating room debridements (2.0 vs 4.4), mean hospital stay (8.1 vs 27.4 days), mean length of therapy (4.1 vs 20.9 days), and mean time to wound closure (4.1 vs 20.9 days). Hypothetical economic model showed potential average reduction of $8143 for operating room debridements between NPWTi-d ($6786) and NPWT ($14,929) patients. There was a $1418 difference in average therapy costs between groups ($799/NPWTi-d vs $2217/NPWT). CONCLUSIONS: In this study, NPWTi-d appeared to assist in wound cleansing and exudate removal, which may have allowed for earlier wound closure compared to NPWT. Hypothetical economic model findings illustrate potential cost-effectiveness of NPWTi-d compared to NPWT.