Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
JAMA Surg. 2018 Feb 1;153(2):130-135. doi: 10.1001/jamasurg.2017.3549.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a percutaneous transfemoral balloon technique used in select centers for resuscitation and temporary hemostasis, often instead of emergency department thoracotomy. The ability to perform aortic occlusion (AO) with an intravascular device allows focused occlusion at the most distal level to perfuse proximal regions while slowing hemorrhage to injured areas.
To describe what is to date the largest single-institution experience with REBOA in the United States.
DESIGN, SETTING, AND PARTICIPANTS: Use of REBOA at an urban tertiary care facility for severe traumatic hemorrhage, traumatic arrest (AR), or nontraumatic hemorrhage (NTH) was investigated from February 1, 2013, to January 31, 2017, among 90 patients who were not responsive or were transiently responsive to resuscitation measures, or were in arrest, from presumed hemorrhage below the diaphragm. Possible causes were trauma or nontrauma-related hemorrhage. Patients with ruptured aortic aneurysms were excluded.
In-hospital mortality.
Of the 90 patients in the study (15 women and 75 men; mean [SD] age, 41.5 [17.4] years), 29 underwent REBOA for severe traumatic hemorrhage, 50 for AR, and 11 for NTH. For the patients with severe traumatic hemorrhage and AR, the median age was 36.2 years (interquartile range, 25.3-55.5 years), mean (SD) admission Glasgow Coma Scale score was 6 (5), and median Injury Severity Score was 39 (interquartile range, 10-75). The distal thoracic aorta was occluded in 73 patients (81%), and in all patients with AR. A total of 17 patients (19%) had distal abdominal AO. Mean (SD) systolic blood pressure improved in patients with severe traumatic hemorrhage, from 68 (28) mm Hg prior to AO, to 131 (12) mm Hg after AO (P < .001). Percutaneous access was used in 30 patients (33%), including 13 patients with AR (26%), and groin cutdown in 60 patients (67%), including 37 patients with AR (74%). Overall 30-day mortality was 62% (n = 56): 11 (39%) in patients with severe traumatic hemorrhage and 45 (90%) in patients with AR. Of the patients with AR, 29 (58%) had return of spontaneous circulation and 11 of those patients (38%) survived to the operating room. All patients who survived AR gained full neurologic recovery. No aortoiliac injury or limb loss occurred from REBOA use. Eleven patients underwent REBOA for NTH; 7 (64%) were in arrest. Overall in-hospital mortality for patients with NTH was 36% (n = 4). No procedural complications occurred in this group.
REBOA is a minimally invasive alternative to emergency department thoracotomy with aortic cross-clamp to temporize noncompressible torso hemorrhage and obtain proximal control in both traumatic and nontraumatic causes of hemorrhage. REBOA can also be used for more targeted AO in the distal aorta for pelvic, junctional, or extremity hemorrhage.
经股动脉逆行主动脉球囊阻断术（REBOA）是一种经皮股动脉球囊技术，在一些中心用于复苏和临时止血，通常替代急诊开胸术。使用血管内装置进行主动脉阻断（AO）的能力允许在最远端进行集中阻断，以向近端区域灌注，同时减缓受伤区域的出血。
描述迄今为止美国最大的单中心 REBOA 经验。
设计、地点和参与者：2013 年 2 月 1 日至 2017 年 1 月 31 日，在一家城市三级护理机构，对因严重创伤性出血、创伤性骤停（AR）或非创伤性出血（NTH）而接受 REBOA 的 90 名患者进行了研究，这些患者对复苏措施没有反应或反应短暂，或处于假定膈肌以下出血性骤停状态。可能的原因是创伤或非创伤相关的出血。排除了破裂的主动脉瘤患者。
院内死亡率。
在这项研究中的 90 名患者（15 名女性和 75 名男性；平均[标准差]年龄，41.5[17.4]岁）中，29 名因严重创伤性出血、50 名因 AR 和 11 名因 NTH 而行 REBOA。对于严重创伤性出血和 AR 的患者，中位年龄为 36.2 岁（四分位距，25.3-55.5 岁），入院时格拉斯哥昏迷评分的平均值（SD）为 6（5），损伤严重程度评分的中位数为 39（四分位距，10-75）。在 73 名患者（81%）中阻断了远端胸主动脉，在所有 AR 患者中均进行了阻断。共有 17 名（19%）患者进行了远端腹部 AO。严重创伤性出血患者的收缩压从 AO 前的 68（28）mmHg 改善至 AO 后的 131（12）mmHg（P<.001）。30 名患者（33%）采用了经皮入路，包括 13 名 AR 患者（26%），60 名患者（67%）采用了股动脉切开术，包括 37 名 AR 患者（74%）。总体 30 天死亡率为 62%（n=56）：11 名（39%）因严重创伤性出血，45 名（90%）因 AR。在 AR 患者中，29 名（58%）恢复了自主循环，其中 11 名（38%）存活至手术室。所有存活的 AR 患者均完全恢复了神经功能。REBOA 无主动脉髂动脉损伤或肢体丧失。11 名患者因 NTH 行 REBOA；7 名（64%）处于骤停状态。NTH 患者的院内总体死亡率为 36%（n=4）。该组未发生任何手术并发症。
REBOA 是一种微创替代急诊开胸术和主动脉夹闭术，用于暂时控制不可压缩的躯干出血，并在创伤性和非创伤性出血原因中获得近端控制。REBOA 还可用于远端主动脉的更靶向性 AO，以治疗骨盆、交界处或四肢出血。
