From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
J Trauma Acute Care Surg. 2016 Nov;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S128-S132. doi: 10.1097/TA.0000000000001104.
Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings.
We performed a 4-year retrospective review of all RTs performed at our Level I trauma center. Patients with in-hospital mortality and who underwent subsequent autopsies were included. Patients were divided into blunt and penetrating trauma with and without thoracic injuries. Autopsy reports were reviewed to identify vascular and solid organ injuries. Outcome measure was potential benefit with REBOA. Potential benefit with REBOA was defined based on the ability to safely deploy REBOA. In patients without cardiac, aortic, and major pulmonary vasculature injuries, REBOA was considered potentially beneficial. In all other patients, it was considered as nonbeneficial.
A total of 98 patients underwent an RT, of whom 87 had subsequent autopsies and were reviewed. The mean age was 35.25 (SD, 17.85) years, mean admission systolic blood pressure was 51.38 (SD, 70.11) mm Hg, median Injury Severity Score was 29 (interquartile range [IQR], 25-42), and 44 had penetrating injury. Resuscitative endovascular balloon occlusion of the aorta would have been potentially beneficial in 51.2% of patients (22 of 43 patients) with blunt mechanism of trauma, whereas REBOA would have been potentially beneficial in 38.6% of patients (17 of 44 patients) with penetrating mechanism of trauma. A subgroup analysis showed that REBOA use would have been potentially beneficial in 50.0% of blunt thoracic and 33.3% of penetrating thoracic trauma patients.
There are a great enthusiasm and premature efforts to introduce REBOA as an alternative to RT. While there exists a great potential for benefit with REBOA use in the management of noncompressible torso hemorrhage, the current indications for REBOA need to be defined better. Patients with penetrating chest trauma in extremis should be considered an absolute contraindication for REBOA use. The majority of patients with blunt trauma in extremis may potentially benefit from REBOA. However, better criteria will help increase these patients who may potentially benefit from REBOA placement.
Therapeutic study, level V.
在因出血性休克导致急性骤停的患者中，进行抢救性开胸术（RT）一直是标准疗法。然而，随着主动脉球囊阻断复苏术（REBOA）的发展，其作为 RT 等高度病态干预的潜在辅助手段的作用正在被讨论。本研究旨在根据尸检结果确定最有可能从 REBOA 使用中受益的患者。
我们对我们的一级创伤中心进行的所有 RT 进行了为期 4 年的回顾性分析。纳入院内死亡并进行后续尸检的患者。将患者分为钝性和穿透性创伤，有无胸部损伤。对尸检报告进行了回顾，以确定血管和实体器官损伤。结果测量为 REBOA 的潜在益处。根据安全部署 REBOA 的能力来定义 REBOA 的潜在益处。在没有心脏、主动脉和主要肺血管损伤的患者中，REBOA 被认为是潜在有益的。在所有其他患者中，REBOA 被认为是无益的。
共有 98 名患者接受了 RT，其中 87 名随后进行了尸检并进行了回顾。平均年龄为 35.25（SD，17.85）岁，平均入院收缩压为 51.38（SD，70.11）mmHg，损伤严重程度评分中位数为 29（四分位距 [IQR]，25-42），44 例为穿透伤。对于钝性创伤机制的患者，REBOA 将在 51.2%（43 例患者中的 22 例）的患者中具有潜在益处，而对于穿透性创伤机制的患者，REBOA 将在 38.6%（44 例患者中的 17 例）的患者中具有潜在益处。亚组分析显示，REBOA 的使用在 50.0%的钝性胸部创伤和 33.3%的穿透性胸部创伤患者中具有潜在益处。
人们对引入 REBOA 作为 RT 的替代方法表现出极大的热情和过早的努力。虽然在管理不可压缩性躯干出血方面，REBOA 的使用具有很大的潜在益处，但目前需要更好地定义 REBOA 的适应证。处于紧急状态的穿透性胸部创伤患者应被视为 REBOA 使用的绝对禁忌证。处于紧急状态的大多数钝性创伤患者可能会从 REBOA 中受益。然而，更好的标准将有助于增加可能从 REBOA 放置中受益的患者数量。
治疗性研究，5 级。
