Damage Control Clinical Trial
Official title:
Jinling Hospital, Medical School of Nanjing University
Acute mesenteric ischemia (AMI) is a rare but catastrophic abdominal vascular emergency associated with daunting mortality comparable to myocardial infarction or cerebral stroke. Damage control surgery has been extensively used in severe traumatic patients. Very urgent, there was no large-scale in-depth study when extended to a nontrauma setting, especially in the intestinal stroke center. Recently, the liberal use of OA as a damage control surgery adjunct has been proved to improve the clinical outcome in acute superior mesenteric artery occlusion patients. However, there was little information when extended to a prospective study. The purpose of this prospective cohort study was to evaluate whether the application of damage control surgery concept in AMI was related to avoiding postoperative abdominal infection, reduced secondary laparotomy, reduced mortality and improved the clinical outcomes in short bowel syndrome.
Acute mesenteric ischemia (AMI) is a rare but catastrophic abdominal vascular emergency
associated with daunting mortality comparable to myocardial infarction or cerebral stroke.
Computed tomographic angiography is the initial diagnostic examination of choice for patients
in whom AMI is a consideration. Computed tomographic angiography can be performed rapidly and
can be used to identify critical arterial stenosis or occlusion as well as providing
information concerning the presence of bowel infarction. An uncommon cause of presentation to
emergency rooms, lack of clinical suspicion often leads to delayed presentation, development
of peritoneal signs, and subsequent staggeringly high mortality rates.
Now in use for over 2 decades, the concept of damage control surgery (DCS) has become an
accepted, proven surgical strategy with wide applicability and success in severe trauma
patients. The concept has been mostly used in the massively injured, exsanguinating patients
with multiple competing surgical priorities. With growing experiences in the application, the
strategy continues to evolve into a nontrauma setting, especially in AMI.
Although an increasing development of endovascular techniques, AMI remains a morbid condition
with a poor short-term and long-term survival rate. Some authors advocated that laparotomy
after mesenteric revascularization serves to evaluate the possible damage to the visceral
organs. Bowel resection as a result of transmural necrosis is carried out according to the
principles of DCS. Bowel resections are performed with staples, leaving the creation of
stomas until the second-look laparotomy. The abdominal wall can be left unsutured and
temporary abdominal closure (TAC) was applied. However, the use of DCS in the setting of AMI
was limited in case series and mostly confined in large university teaching hospitals. The
timing and details of how the DCS incorporated into the treatment algorithm of AMI deserved
further investigations.
An integrated intestinal stroke center (ISC) was established in our department, a national
cutting-edge referral center for intestinal failure, to build up ideal coordination among
gastroenterology physician, gastrointestinal and vascular surgeon, and intervention
radiologist for this therapeutic challenge. DCS was liberally used since ISC was established
in 2010.
In this prospective cohort study, we aimed to compare the clinical outcomes of patients
receiving DCS and non-DCS in the devastating conditions in our single center.
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| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT03466684 -
BIA Guided-fluid Management in Postinjury Open Abdomen
|
N/A |