Trauma Care Systems in Urban Areas: Our Thoughts on the Contrasting Approaches in South Korea and Japan.

Trauma is a major global health issue, causing significant mortality, disability, and healthcare expenses. Since 2012, the Ajou Trauma Center in South Korea has been at the forefront, providing centralized severe trauma care for a population of 9.5 million. In 2022, the center managed 3,500 cases of severe trauma, including 500 helicopter transports, and conducted 2,800 surgeries, with 450 addressing torso trauma. Its exceptional performance has garnered global recognition, solidifying its position among the top advanced trauma centers. In Tokyo, critically ill and major trauma patients are currently transported to the nearest emergency and critical care centers, each serving a population of approximately 0.5 to 0.6 million people. Due to the low incidence of trauma per facility and an aging population, implementing a high level of trauma care and a comprehensive training framework within Japan's existing system poses significant challenges. A comparative analysis of South Korea's centralized system and Tokyo's decentralized approach indicates that the centralized system may lead to the establishment of a more advanced trauma center with ethical and equity considerations, compared to the decentralized approach. Therefore, consolidating major trauma cases in Tokyo shows promise for establishing exceptional trauma centers. This emphasizes the urgent need for Japan to take immediate steps towards a more robust future in trauma care. This assertion aligns with the global discourse on improving trauma care practices and could make a valuable contribution to the scholarly literature on trauma care systems.

Is resuscitative endovascular balloon occlusion of the aorta for computed tomography diagnosis feasible or not? A Japanese single-center, retrospective, observational study.

BACKGROUND: Advances in medical equipment have resulted in changes in the management of severe trauma. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) in this scenario is still unclear. This study aimed to evaluate the usage of REBOA and utility of computed tomography (CT) in the setting of aortic occlusion in our current trauma management. METHODS: This Japanese single-tertiary center, retrospective, and observational study analyzed 77 patients who experienced severe trauma and persistent hypotension between October 2014 and March 2020. RESULTS: All patients required urgent hemostasis. Twenty patients underwent REBOA, 11 underwent open aortic cross-clamping, and 46 did not undergo aortic occlusion. Among patients who underwent aortic occlusion, 19 patients underwent prehemostasis CT, and 7 patients underwent operative exploration without prehemostasis CT for identifying active bleeding sites. The 24-hour and 28-day survival rates in patients who underwent CT were not inferior to those in patients who did not undergo CT (24-hour survival rate, 84.2% vs. 57.1%; 28-day survival rate, 47.4% vs. 28.6%). Moreover, the patients who underwent CT had less discordance between primary hemostasis site and main bleeding site compared with patients who did not undergo CT (5% vs. 71.4%, p = 0.001). In the patients who underwent prehemostasis CT, REBOA was the most common approach of aortic occlusion. Most of the bleeding control sites were located in the retroperitoneal space. There were many patients who underwent interventional radiology for hemostasis. CONCLUSION: In a limited number of patients whose cardiac arrests were imminent and in whom no active bleeding sites could be clearly identified without CT findings, REBOA for CT diagnosis may be effective; however, further investigations are needed. LEVEL OF EVIDENCE: Therapeutic/care management study, level V.

Optimal Treatment for Diverticulum-like Projections of the Retrohepatic Inferior Vena Cava Occurring after Inferior Vena Cava Packing: A Case Report.

INTRODUCTION: Although the outcomes of patients with retrohepatic inferior vena cava (IVC) injury have improved because of damage control (DC) strategies, some rare complications have been observed. CASE PRESENTATION: We present the case of a 35-year-old man with diverticulum-like projections (DLPs) of the retrohepatic IVC that occurred following peri-IVC packing based on DC strategies. The DLPs were treated conservatively with anticoagulant therapy and he recovered completely. CONCLUSIONS: Caution must be exercised regarding such rare complications after abbreviated surgery. Conservative therapy may be the optimal treatment for patients with DLPs of the retrohepatic IVC after peri-IVC packing.