R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA.
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba.
Eur J Emerg Med. 2018 Oct;25(5):348-354. doi: 10.1097/MEJ.0000000000000466.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable alternative to resuscitative thoracotomy (RT) in refractory hemorrhagic patients. We evaluated REBOA strategies using Japanese multi-institutional data.
The DIRECT-IABO investigators registered trauma patients requiring REBOA from 18 hospitals. Patients' characteristics, outcomes, and time in initial treatment were collected and analyzed.
From August 2011 to December 2015, 106 trauma patients were analyzed. The majority of patients were men (67%) (median BMI of 22 kg/m, 96% blunt injured). REBOA occurred in the field (1.9%, all survived >30 days), emergency department (75%), angiography suite (17%), and operating room (1.9%). Initial deployment was at zone I in 93% and partial occlusion in 70% of cases. RT and REBOA were combined in 30 patients (RT+REBOA group) who showed significantly higher injury severity score (44 vs. 36, P=0.001) and chest abbreviated injury scale (4 vs. 3; P<0.001) than the REBOA-alone group (n=76). Frequent cardiopulmonary resuscitation (73%), longer prothrombin time-international normalised ratio, lower pH, and higher lactate were observed in the RT+REBOA. Among 24 h nonsurvivors (n=30) of the REBOA alone, preocclusion systolic blood pressure was lower (43 vs. 72 mmHg; P=0.002), indicating impending cardiac arrest, and duration of occlusion was longer (60 vs. 31 min; P=0.010). In the RT+REBOA (n=30), six survived beyond 24 h, three beyond 30 days, and achieved survival discharge.
Partial occlusion was performed in 70% of patients. Undelayed deployment of REBOA without presenting impending cardiac arrest with shorter balloon occlusion (<30 min at zone I with partial occlusion) might be related to successful hemodynamic stabilization and improved survival. Further evaluation should be performed prospectively.
主动脉球囊阻断复苏术（REBOA）是治疗难治性出血患者的一种可行的剖腹手术替代方法。我们使用日本多机构数据评估了 REBOA 策略。
DIRECT-IABO 研究人员从 18 家医院登记了需要 REBOA 的创伤患者。收集并分析了患者的特征、结局和初始治疗时间。
从 2011 年 8 月至 2015 年 12 月，分析了 106 例创伤患者。大多数患者为男性（67%）（中位数 BMI 为 22kg/m，96%为钝性损伤）。REBOA 在现场（1.9%，所有患者>30 天存活）、急诊科（75%）、血管造影室（17%）和手术室（1.9%）进行。初始部署在 93%的情况下为 I 区，70%的情况下为部分闭塞。30 名患者（RT+REBOA 组）同时进行了 RT 和 REBOA，其损伤严重程度评分（44 分比 36 分，P=0.001）和胸部损伤严重程度评分（4 分比 3 分；P<0.001）明显高于单独 REBOA 组（n=76）。RT+REBOA 组中频繁进行心肺复苏（73%）、更长的凝血酶原时间国际标准化比值、更低的 pH 值和更高的乳酸水平。在单独接受 REBOA 的 24 小时内非幸存者（n=30）中，预闭塞收缩压较低（43 比 72mmHg；P=0.002），提示即将发生心脏骤停，并且闭塞时间较长（60 比 31 分钟；P=0.010）。在 RT+REBOA 组（n=30）中，6 名患者在 24 小时后存活，3 名患者在 30 天后存活，并且实现了生存出院。
70%的患者进行了部分闭塞。不出现即将发生心脏骤停的情况下尽早进行 REBOA 部署，且球囊阻塞时间较短（I 区部分阻塞时<30 分钟），可能与成功的血流动力学稳定和改善生存有关。应前瞻性地进行进一步评估。
