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BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is gaining popularity worldwide for managing hypotensive trauma patients. Vascular access complications related to REBOA placement have been reported, with some cases resulting in permanent morbidity. We aim to capitalize on the increase in literature to further describe and estimate the incidence of REBOA-associated vascular access complications in adult trauma patients. METHODS: We searched Medline, EMBASE, Scopus, and CINAHL for studies reporting vascular access complications of REBOA in adult trauma patients from inception to October 14, 2021. Studies reporting data from adult trauma patients who underwent REBOA insertion were eligible. Exclusion criteria included patients 15 years and younger, nontrauma patients, non-REBOA use, non-vascular access complications and patient duplication. Study data was abstracted using the PRISMA checklist and verified independently by three reviewers. Meta-analysis of proportions was performed using a random effects model with Freeman-Turkey double-arcsine transformation. Post hoc meta-regression by year of publication, sheath-size, and geographic region was also performed. The incidence of vascular access complications from REBOA insertion was the primary outcome of interest. Subgroup analysis was performed by degree of bias, sheath size, technique of vascular access, provider specialty, geographical region, and publication year. RESULTS: Twenty-four articles were included in the systematic review and the meta-analysis, for a total of 675 trauma patients who underwent REBOA insertion. The incidence of vascular access complications was 8% (95% confidence interval, 5%-13%). In post hoc meta-regression adjusting for year of publication and geographic region, the use of a smaller (7-Fr) sheath was associated with a decreased incidence of vascular access complications (odds ratio, 0.87; 95% confidence interval, 0.75-0.99; p = 0.046; R 2 = 35%; I 2 = 48%). CONCLUSION: This study provides a benchmark for quality of care in terms of vascular access complications related to REBOA insertion in adult trauma patients. Smaller sheath size may be associated with a decrease in vascular access complications. LEVEL OF EVIDENCE: Systematic Review and Meta-Analysis; Level III.

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OBJECTIVE: to evaluate the evolution of severe abdominal trauma patients, for whom the massive transfusion protocol was triggered, and who were submitted to Computed Axial Tomography (CAT) in the emergency room (ER), in order to verify the patient's prognosis and the diagnostic efficiency of CAT in this scenario. METHODS: retrospective, longitudinal and observational study performed at a referral center for trauma care in Curitiba, Parana, Brazil. We selected 60 severe abdominal trauma patients who had massive transfusion protocol activation and divided them into two groups: patients who underwent CAT at ER and patients who did not. We verified the diagnostic accuracy of CAT-scan examination and compared the number of deaths, hospitalization time, and transfused blood components in both groups. RESULTS: considering the 60 patients, 66.67% received red blood cells at ER; 33.3% underwent CAT on admission due to hemodynamic improvement, and 66.7% did not perform the examination at the entrance. The percentage of deaths was 35% in both groups. Considering the two groups, the difference between the mean lengths of hospital stay was not statistically significant, as well as the difference between the mean numbers of transfused red blood cells. In the group that underwent CAT, 45% did not require exploratory laparotomy. CONCLUSION: CAT could be rapidly performed in patients with hemodynamic instability on arrival at ER, sparing some patients from an unnecessary exploratory laparotomy and not significantly influencing mortality.

OBJETIVO: avaliar a evolução de pacientes vítimas de trauma abdominal grave, nos quais o protocolo de transfusão maciça foi acionado, e que foram submetidos à Tomografia Axial Computadorizada (TAC) no Pronto Socorro (PS), com o intuito de verificar o prognóstico do paciente e a eficiência diagnóstica da TAC nesse cenário. MÉTODOS: estudo retrospectivo, longitudinal e observacional, feito em centro de referência para trauma. Foram selecionados 60 pacientes vítimas de trauma abdominal grave que ativaram o protocolo de transfusão maciça, divididos em dois grupos: os submetidos à TAC no PS e os que não foram. Verificou-se a acurácia da TAC, comparou-se o número de óbitos nos dois grupos, o tempo de internamento e os hemocomponentes transfundidos. RESULTADOS: dos 60 pacientes, 66,67% receberam concentrados de hemácias ainda no PS; 33,3% foram submetidos à TAC na admissão, pela melhora hemodinâmica, e 66,7% não realizaram o exame na entrada. O percentual de óbitos foi de 35% em ambos os grupos. A diferença entre as médias do tempo de internamento entre os grupos não foi estatisticamente significativa, assim como a média da quantidade de concentrado de hemácias transfundido. No grupo que fez TAC, 45% não necessitaram de laparotomia exploratória. CONCLUSÃO: a TAC pôde ser realizada de maneira rápida em pacientes com instabilidade hemodinâmica na chegada ao PS, não influenciou significativamente a mortalidade e poupou alguns doentes de uma laparotomia exploratória desnecessária.

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RESUMO Objetivo: avaliar a evolução de pacientes vítimas de trauma abdominal grave, nos quais o protocolo de transfusão maciça foi acionado, e que foram submetidos à Tomografia Axial Computadorizada (TAC) no Pronto Socorro (PS), com o intuito de verificar o prognóstico do paciente e a eficiência diagnóstica da TAC nesse cenário. Métodos: estudo retrospectivo, longitudinal e observacional, feito em centro de referência para trauma. Foram selecionados 60 pacientes vítimas de trauma abdominal grave que ativaram o protocolo de transfusão maciça, divididos em dois grupos: os submetidos à TAC no PS e os que não foram. Verificou-se a acurácia da TAC, comparou-se o número de óbitos nos dois grupos, o tempo de internamento e os hemocomponentes transfundidos. Resultados: dos 60 pacientes, 66,67% receberam concentrados de hemácias ainda no PS; 33,3% foram submetidos à TAC na admissão, pela melhora hemodinâmica, e 66,7% não realizaram o exame na entrada. O percentual de óbitos foi de 35% em ambos os grupos. A diferença entre as médias do tempo de internamento entre os grupos não foi estatisticamente significativa, assim como a média da quantidade de concentrado de hemácias transfundido. No grupo que fez TAC, 45% não necessitaram de laparotomia exploratória. Conclusão: a TAC pôde ser realizada de maneira rápida em pacientes com instabilidade hemodinâmica na chegada ao PS, não influenciou significativamente a mortalidade e poupou alguns doentes de uma laparotomia exploratória desnecessária.

ABSTRACT Objective: to evaluate the evolution of severe abdominal trauma patients, for whom the massive transfusion protocol was triggered, and who were submitted to Computed Axial Tomography (CAT) in the emergency room (ER), in order to verify the patient's prognosis and the diagnostic efficiency of CAT in this scenario. Methods: retrospective, longitudinal and observational study performed at a referral center for trauma care in Curitiba, Parana, Brazil. We selected 60 severe abdominal trauma patients who had massive transfusion protocol activation and divided them into two groups: patients who underwent CAT at ER and patients who did not. We verified the diagnostic accuracy of CAT-scan examination and compared the number of deaths, hospitalization time, and transfused blood components in both groups. Results: considering the 60 patients, 66.67% received red blood cells at ER; 33.3% underwent CAT on admission due to hemodynamic improvement, and 66.7% did not perform the examination at the entrance. The percentage of deaths was 35% in both groups. Considering the two groups, the difference between the mean lengths of hospital stay was not statistically significant, as well as the difference between the mean numbers of transfused red blood cells. In the group that underwent CAT, 45% did not require exploratory laparotomy. Conclusion: CAT could be rapidly performed in patients with hemodynamic instability on arrival at ER, sparing some patients from an unnecessary exploratory laparotomy and not significantly influencing mortality.

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Dengue is a viral disease transmitted by the Aedes aegypti mosquito. It is endemic in Puerto Rico and the Caribbean with periodic epidemics occurring at varying intervals. There are three dengue serotypes present in Puerto Rico, at the present time. The clinical manifestations of dengue in Puerto Rico are presented from a historical perspective. Dengue in Puerto Rico has evolved from a clinically mild illness in the 1960's to a devastating disease with hemorrhagic manifestations in the 1980's and dengue shock syndrome in 1987. The approach to clinical diagnosis and management is presented with emphasis on early recognition, performance of tourniquet test, serial hematocrits and aggressive intravenous fluid replacement with crystalloids of colloids in DSS. The best way to treat dengue is eliminating the vector, therefore, prevention.

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Dengue es una enfermedad viral transmitida por el mosquito hembra de Aedes aegypti; es endémico con brotes espidémicos periódicos en Puerto Rico y en el Caribe. Hay en el momento tres serotipos de dengue en Puerto Rico. Las manifestaciones clínicas de dengue en Puerto Rico se presentan desde una perspectiva histórica. Dengue en Puerto Rico ha evolucionado de una enfermedad son consecuencias clínicas en los años de 1960 a una enfermedad devastadora con manifestaciones hemorrágicas en los años 1980, al Síndrome de "Dengue Shcok" en 1987. Se presenta la manera para realizar el diagnóstico clínico y el manejo del paciente con dengue. Se enfatiza el reconocimiento temprano de la enfermedad, el hacer la prueba torniquete y hematocritos seriados y el reemplazo agresivo de líquidos endovenosos con soluciones de cristaloides o de coloides en el SDS. La mejor manera de tratar el dengue es eliminando el vector, por lo tanto, la prevención

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