Uchino Hayaki, Tamura Nobuichiro, Echigoya Ryosuke, Ikegami Tetsunori, Fukuoka Toshio
Department of Emergency Medicine and Surgery, Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Japan.
Am J Case Rep. 2016 Nov 1;17:810-813. doi: 10.12659/ajcr.900267.
BACKGROUND Non-compressible torso hemorrhage continues to be the leading cause of preventable death in trauma patients. Recent case series report that resuscitative endovascular balloon occlusion of the aorta (REBOA) in the trauma population is a technically feasible method to manage the patients with exsanguinating hemorrhage. On the other hand, it seems that REBOA is being widely promoted prematurely. Complications due to REBOA haven't been reported much in the literature, and they could have been underestimated. CASE REPORT An 86-year-old female presented to our emergency department following a pedestrian-vehicle accident. On admission, she was hemodynamically unstable with systolic blood pressure (SBP) of 78 mm Hg. She responded to fluid administration, and computed tomography (CT) scan showed cerebral contusion, subarachnoid hemorrhage, pelvic fracture with contrast extravasation, and thoracic spine fracture. Her condition deteriorated after the CT scan, and she became hemodynamically unstable. REBOA was inserted and inflated. Her blood pressure recovered and even became as high as SBP of 180 mm Hg. Transarterial embolization for pelvic fracture was successfully performed. A subsequent head CT scan showed massive intracranial hemorrhage with penetration to the ventricle, which was fatal. She died on the same day due to cerebral herniation. CONCLUSIONS REBOA is now considered as an alternative to resuscitative thoracotomy or even widely indicated to control hemorrhage. We should be more cautious about using REBOA for polytrauma patients since it could make hemorrhage worse. Further research, assessing its potential complications and safety, will be required to elucidate clear indications for REBOA in trauma populations.
不可压缩性躯干出血仍然是创伤患者可预防死亡的主要原因。最近的病例系列报告显示，在创伤人群中，复苏性血管内主动脉球囊阻断术（REBOA）是一种技术上可行的方法，用于治疗出血性休克患者。另一方面，REBOA似乎被过早地广泛推广。REBOA引起的并发症在文献中报道不多，可能被低估了。病例报告：一名86岁女性在行人与车辆碰撞事故后被送往我院急诊科。入院时，她血流动力学不稳定，收缩压（SBP）为78 mmHg。她对液体输注有反应，计算机断层扫描（CT）显示脑挫伤、蛛网膜下腔出血、骨盆骨折伴造影剂外渗和胸椎骨折。CT扫描后她的病情恶化，血流动力学变得不稳定。插入并充盈REBOA。她的血压恢复，甚至高达SBP 180 mmHg。成功进行了骨盆骨折的经动脉栓塞术。随后的头部CT扫描显示大量颅内出血并破入脑室，这是致命的。她于当天因脑疝死亡。结论：REBOA现在被认为是复苏性开胸手术的替代方法，甚至被广泛用于控制出血。对于多发伤患者使用REBOA我们应该更加谨慎，因为它可能会使出血情况恶化。需要进一步研究评估其潜在并发症和安全性，以明确REBOA在创伤人群中的明确适应证。
