Emergency treatment of splenic injury in a novel mobile minimally invasive interventional shelter following disaster: a feasibility study

Abstract

Background: There has been an increase in natural disasters in recent years, which leads to a great number of injuries and deaths. It still remains an unsolved problem to treat patients with vascular injury of solid organs effectively following natural disasters, but on-spot emergency interventional transcatheter arterial embolization (TAE) has been highly recommended to cure serious vascular injury of solid organs nowadays. Spleen is the most vulnerable abdominal organ, severe arterial hemorrhage of which can cause death if untreated timely. In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters.

Methods: First, the mobile minimally invasive interventional shelter was unfolded in the field, and then disinfection and preoperative preparation were performed immediately. Eight large animal models of splenic injury were created, and angiograms were performed using a digital subtraction angiography machine in the mobile minimally invasive interventional shelter, and then the hemostatic embolizations of injured splenic artery were performed following the established convention of rapid intervention therapy. The operating time was recorded, and the survival condition and postoperative complications were observed for two weeks.

Results and discussion: The average time of unfolding the shelter, and performing disinfection and preoperative preparation was 33 ± 7 min. The number of colonies in the sterilized shelter body was 86 ± 13 cfu/m(3). The average TAE time was 31 ± 7 min. All the hemostatic embolizations of splenic injury were performed successfully in the mobile minimally invasive interventional shelter during the operation. A pseudoaneurysm was found in an animal model using angiography two weeks after the operation. The primary clinical success rate of embolization was 87.5%. The two-week survival rate in all animal models of splenic injury was 100%.

Conclusions: Our findings in the current study demonstrate that the mobile minimally invasive interventional shelter can be adapted to the field perfectly and complete emergency surgical intervention for splenic injury efficiently and safely. Therefore, on-spot emergency interventional TAE for vascular injury of solid organs (e.g. spleen) in mobile minimally invasive interventional shelter is available and effective.

Figure 1

Different states of the novel mobile minimally invasive interventional shelter. A. transport state of the shelter; B. the interiors of the shelter; C. unfolded state of the shelter; D. working state of the shelter.

Figure 2

Positioning sketch of the staff in working field interventional cabin. ① performer ② assistant ③ nurse ④ technician ⑤ head nurse ⑥ triage doctor.

Figure 3

The angiographic comparison of normal spleen, bleeding of injured splenic artery and hemostasis after embolization. A. Angiographic image of normal spleen. B. Splenic injury model (white arrow shows the retention of contrast agent). C. Successful embolization of splenic artery (white arrow shows the distal portion of damaged artery is embolized and the hemorrhage is controlled).