First clinical experiences of concurrent bleeding control and intracranial pressure monitoring using a hybrid emergency room system in patients with multiple injuries

Background: The outcomes of multiple injury patients with concomitant torso hemorrhage and traumatic brain injury (TBI) are very poor. The hybrid emergency room system (HERS) is a trauma management system designed to complete resuscitation, computed tomography (CT), surgery, angioembolization, and intracranial pressure (ICP) monitoring all in one trauma resuscitation room without patient transfer. We aimed to review the outcomes of polytrauma patients who underwent concurrent bleeding control and ICP monitoring using the HERS. Methods: In this retrospective observational study, we enrolled patients who underwent concurrent bleeding control and ICP monitoring using the HERS between August 2011 and June 2018. Initial data on vital signs, Injury Severity Score (ISS), probability of survival (Ps) calculated by the Trauma and Injury Severity Score (TRISS), intervention type, 28-day mortality, and Extended Glasgow Outcome Scale at 6months after injury were collected. Continuous variables were expressed as the median (25th and 75th percentiles) and categorical variables as numbers (%). Results: Ten patients were included in the analysis. The injury severity of the patients was as high as an ISS of 58 (50-64) and TRISS Ps of 0.15 (0.02-0.36). Seven of the 10 (70%) patients had hemodynamic instability within 30min from arrival. The recorded durations from arrival to events were CT examination 9 (6-16) min, bleeding control procedure 29 (22-42) min, and neurosurgical intervention 39 (31-53) min. Four of the 10 patients (40%) survived to discharge, and two of them (20%) were able to live independently at 6months after injury. Conclusions: The concurrent performance of bleeding control procedure and ICP monitoring would be feasible in HERS settings among polytrauma patients with exsanguinating hemorrhage and TBI.