Norii Tatsuya, Miyata Shin, Terasaka Yusuke, Guliani Sundeep, Lu Stephen W, Crandall Cameron
From the Department of Emergency Medicine (T.N., C.C.), University of New Mexico, Albuquerque, New Mexico; Children's Hospital Los Angeles (S.M.), Los Angeles, California; Kenwakai Otemachi Hospital (Y.T.), Kitakyushu, Japan; and Department of Surgery (S.G., S.W.L.), University of New Mexico, Albuquerque, New Mexico.
J Trauma Acute Care Surg. 2017 May;82(5):915-920. doi: 10.1097/TA.0000000000001347.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has received increasing attention for critically uncontrolled hemorrhagic shock. However, the efficacy of REBOA in patients in youth is unknown.
The aim of this study was to evaluate the mortality and characteristics of patients of age ≤18 years with severe traumatic injury who received REBOA.
We retrospectively analyzed observational cohort data from the Japan Trauma Data Bank (JTDB) from 2004 to 2015. All patients ≤18 years old who underwent REBOA were included. Clinical characteristics and mortalities were analyzed and compared among patients ≤15 years old (young children) and 16-18 years old (adolescents).
Of the 236,698 patients in the JTDB (2004-2015), 22,907 patients were 18 years old or younger. A total of 3,440 patients without survival data were excluded. Of the remaining 19,467, 54 (0.3%) patients underwent REBOA, among which 15 (27.8%) were young children. Both young children and adolescents who underwent REBOA were seriously injured (median Injury Severity Score [ISS], 41 and 38, respectively). Also, 53.3% of young children and 38.5% of adolescents survived to discharge after undergoing REBOA.
In a cohort of young trauma patients from the JTDB who underwent REBOA to control hemorrhage, we found that both young children and adolescents who underwent REBOA were seriously injured and had an equivalent survival rate compared to the reported survival rate from studies in adults. REBOA treatment may be a reasonable option in severely injured young patients in the appropriate clinical settings. Further prospective studies are needed to confirm our findings.
Epidemiologic study, level III; therapeutic study, level IV.
主动脉内复苏球囊阻断术（REBOA）在严重失控性出血性休克治疗中受到越来越多的关注。然而，REBOA在青少年患者中的疗效尚不清楚。
本研究旨在评估接受REBOA治疗的年龄≤18岁的严重创伤患者的死亡率及特征。
我们回顾性分析了日本创伤数据库（JTDB）2004年至2015年的观察性队列数据。纳入所有接受REBOA治疗的≤18岁患者。对≤15岁（幼儿）和16 - 18岁（青少年）患者的临床特征和死亡率进行分析和比较。
在JTDB的236,698例患者（2004 - 2015年）中，22,907例患者年龄为18岁及以下。共排除3,440例无生存数据的患者。在其余19,467例患者中，54例（0.3%）接受了REBOA治疗，其中15例（27.8%）为幼儿。接受REBOA治疗的幼儿和青少年均受重伤（损伤严重程度评分[ISS]中位数分别为41和38）。此外，53.3%的幼儿和38.5%的青少年在接受REBOA治疗后存活至出院。
在JTDB中接受REBOA治疗以控制出血的年轻创伤患者队列中，我们发现接受REBOA治疗的幼儿和青少年均受重伤，且与成人研究报告的生存率相当。在适当的临床环境中，REBOA治疗可能是重伤年轻患者的合理选择。需要进一步的前瞻性研究来证实我们的发现。
流行病学研究，III级；治疗性研究，IV级。
