一种新型非透视下的、用于失血性休克的抢救性血管内主动脉球囊阻断系统。
A novel fluoroscopy-free, resuscitative endovascular aortic balloon occlusion system in a model of hemorrhagic shock.
机构信息
59th Medical Wing, Lackland Air Force Base, San Antonio, Texas, USA.
出版信息
J Trauma Acute Care Surg. 2013 Jul;75(1):122-8. doi: 10.1097/ta.0b013e3182946746.
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially lifesaving maneuver in the setting of hemorrhagic shock. However, emergent use of REBOA is limited by existing technology, which requires large sheath arterial access and fluoroscopy-guided balloon positioning. The objectives of this study were to describe a new, fluoroscopy-free REBOA system and to compare its efficacy to existing technology. An additional objective was to characterize the survivability of 60 minutes of REBOA using these systems in a model of hemorrhagic shock.
METHODS
Swine (70-88 kg) in shock underwent 60 minutes of REBOA using either a self-centering, one component prototype balloon system (PBS, n = 8) inserted (8 Fr) and inflated without fluoroscopy or a two-component, commercially available balloon system (CBS, n = 8) inserted (14 Fr) with fluoroscopic guidance. Following REBOA, resuscitation occurred for 48 hours with blood, crystalloid, and vasopressors. End points included accurate balloon positioning, hemodynamics, markers of ischemia, resuscitation requirements, and mortality.
RESULTS
Posthemorrhage mean arterial pressure (mm Hg) was similar in the CBS and PBS groups (35 [8] vs. 34 [5]; p = 0.89). Accurate balloon positioning and inflation occurred in 100% of the CBS and 88% of the PBS group. Following REBOA, mean arterial pressure increased comparably in the CBS and PBS groups (81 [20] vs. 89 [16]; p = 0.21). Lactate peaked in the CBS and PBS groups (10.8 [1.4] mmol/L vs. 13.2 [2.1] mmol/L; p = 0.01) 45 minutes following balloon deflation but returned to baseline by 24 hours. Mortality was similar between the CBS and PBS groups (12% vs. 25%, p = 0.50).
CONCLUSION
This study reports the feasibility and efficacy of a novel, fluoroscopy-free REBOA system in a model of shock. Despite a significant physiologic insult, 60 minutes of REBOA is tolerated and recoverable. Development of lower profile, fluoroscopy-free endovascular balloon occlusion catheters may allow proactive aortic control in patients at risk for hemorrhagic shock and cardiovascular collapse.
背景
在出血性休克的情况下，主动脉球囊阻断复苏（REBOA）是一种潜在的救生手段。然而，REBOA 的紧急使用受到现有技术的限制，该技术需要大的鞘管动脉入路和透视引导下的球囊定位。本研究的目的是描述一种新的、无透视的 REBOA 系统，并将其与现有技术进行比较。另一个目的是在出血性休克模型中使用这些系统来描述 60 分钟的 REBOA 的存活率。
方法
休克猪（70-88 公斤）使用自行居中、单组件原型球囊系统（PBS，n=8）进行 60 分钟的 REBOA，该系统无需透视即可插入（8Fr）并充气，或使用双组件、市售球囊系统（CBS，n=8）进行 60 分钟的 REBOA，该系统需要透视引导插入（14Fr）。REBOA 后，使用血液、晶体液和血管加压药进行 48 小时的复苏。终点包括准确的球囊定位、血流动力学、缺血标志物、复苏需求和死亡率。
结果
CBS 和 PBS 组的平均动脉压（mmHg）在出血后相似（35[8]与 34[5]；p=0.89）。CBS 和 PBS 组的球囊定位和充气均准确，成功率为 100%。REBOA 后，CBS 和 PBS 组的平均动脉压均有可比的增加（81[20]与 89[16]；p=0.21）。CBS 和 PBS 组的乳酸峰值均出现在球囊放气后 45 分钟（10.8[1.4]mmol/L 与 13.2[2.1]mmol/L；p=0.01），但在 24 小时内恢复至基线。CBS 和 PBS 组的死亡率相似（12%与 25%，p=0.50）。
结论
本研究报告了一种新型、无透视的 REBOA 系统在休克模型中的可行性和疗效。尽管存在明显的生理损伤，60 分钟的 REBOA 是可以耐受和恢复的。开发更薄的、无透视的血管内球囊闭塞导管可能允许在有出血性休克和心血管崩溃风险的患者中主动控制主动脉。
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