R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, USA.
Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
Emerg Med J. 2017 Dec;34(12):793-799. doi: 10.1136/emermed-2016-206383. Epub 2017 Aug 31.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) performed by emergency physicians has been gaining acceptance as a less invasive technique than resuscitative thoracotomy.
To evaluate access-related complications and duration of occlusions during REBOA.
Patients with haemorrhagic shock requiring REBOA, from 18 hospitals in Japan, included in the DIRECT-IABO Registry were studied. REBOA-related characteristics were compared between non-survivors and survivors at 24 hours. 24-Hour survivors were categorised into groups with small (≤8 Fr), large (≥9 Fr) or unusual sheaths (oversized or multiple) to assess the relationship between the sheath size and complications. Haemodynamic response, occlusion duration and outcomes were compared between groups with partial and complete REBOA.
Between August 2011 and December 2015, 142 adults undergoing REBOA were analysed. REBOA procedures were predominantly (94%) performed by emergency medicine (EM) physicians. The median duration of the small sheath (n=53) was 19 hours compared with 7.5 hours for the larger sheaths (P=0.025). Smaller sheaths were more likely to be removed using external manual compression (96% vs 45%, P<0.001). One case of a common femoral artery thrombus (large group) and two cases of amputation (unusual group) were identified. Partial REBOA was carried out in more cases (n=78) and resulted in a better haemodynamic response than complete REBOA (improvement in haemodynamics, 92% vs 70%, P=0.004; achievement of stability, 78% vs 51%, P=0.007) and allowed longer occlusion duration (median 58 vs 33 min, P=0.041). No statistically significant difference in 24-hour or 30-day survival was found between partial and complete REBOA.
In Japan, EM physicians undertake the majority of REBOA procedures. Smaller sheaths appear to have fewer complications despite relatively prolonged placement and require external compression on removal. Although REBOA is a rarely performed procedure, partial REBOA, which may extend the occlusion duration without a reduction in survival, is used more commonly in Japan.
与开胸手术相比，急救医生施行的主动脉腔内球囊阻断复苏术（REBOA）作为一种侵入性更小的技术已逐渐被认可。
评估 REBOA 过程中与通路相关的并发症和阻断时间。
本研究纳入了来自日本 18 家医院的接受 REBOA 治疗的失血性休克患者，这些患者均被纳入 DIRECT-IABO 注册研究。比较了 24 小时存活患者和死亡患者的 REBOA 相关特征。将 24 小时存活患者分为小（≤8Fr）、大（≥9Fr）或不常见（超大或多个）鞘管组，以评估鞘管大小与并发症之间的关系。比较部分和完全 REBOA 患者的血流动力学反应、阻断时间和结局。
2011 年 8 月至 2015 年 12 月，共分析了 142 例接受 REBOA 的成年人。REBOA 术主要由急诊医学（EM）医生完成（94%）。小鞘管（n=53）的中位使用时间为 19 小时，而大鞘管的中位使用时间为 7.5 小时（P=0.025）。小鞘管更有可能通过外部手动压迫来移除（96%比 45%，P<0.001）。发现 1 例股总动脉血栓形成（大鞘管组）和 2 例截肢（不常见鞘管组）。部分 REBOA 的实施例数（n=78）多于完全 REBOA，且血流动力学反应更好（血流动力学改善，92%比 70%，P=0.004；达到稳定，78%比 51%，P=0.007），且阻断时间更长（中位 58 比 33 分钟，P=0.041）。部分和完全 REBOA 之间 24 小时或 30 天生存率无统计学差异。
在日本，EM 医生实施了大多数 REBOA 手术。尽管小鞘管的放置时间相对较长，但并发症较少，取出时需要外部压迫。尽管 REBOA 是一种很少进行的手术，但在日本，部分 REBOA 更常用，因为它可能延长阻断时间而不降低生存率。
