From the Division of Trauma and Acute Care Surgery, Department of Surgery (C.A.O., R.M.-N., P.R.O., F.R.), Fundación Valle del Lili, Cali, Colombia; Department of Trauma Critical Care (M.W.P.), Broward General Level I Trauma Center, Fort Lauderdale, FL; Clinical Research Center (R.M.-N.), Fundacion Valle del Lili, Cali, Colombia; Center for Surgery and Public Health, Department of Surgery (J.P.H.-E.), Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA; Trauma and Acute Care Surgery Fellowship (C.A.O., J.J.S., A.M.D.V., A.S.), Universidad del Valle, Cali, Colombia; Division of Trauma and Acute Care Surgery (D.M.), Universidad de Antioquia, Medellín, Colombia; and Division of Trauma and Emergency Surgery, Department of Surgery (J.C.S.), Hospital Vicente Corral Moscoso and Universidad del Azuay, Cuenca, Ecuador.
J Trauma Acute Care Surg. 2018 May;84(5):752-757. doi: 10.1097/TA.0000000000001807.
Recent evidence suggests that resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective life-saving intervention in patients with severe torso trauma. However, the deployment of REBOA in patients with isolated penetrating intrathoracic injuries remains controversial. We propose that a median sternotomy be performed in conjunction with REBOA as a feasible and effective means of hemorrhage control in patients suffering from penetrating chest trauma who present hemodynamically unstable. The objective of our study was to present our initial experience with this approach.
A prospectively collected case series of the use of REBOA (10 Fr) in conjunction with a median sternotomy from January 2015 to December 2016 at a Level I Trauma Center. We included hemodynamically unstable non-compressible torso hemorrhage patients with penetrating chest trauma who underwent intraoperative REBOA deployment plus median sternotomy.
A total of 68 trauma-related emergent thoracic surgeries were performed at our institution during the study period. Of these, seven suffered from penetrating chest trauma and non-compressible torso hemorrhage and underwent REBOA plus median sternotomy. Six out of the seven patients suffered intrathoracic vascular injuries: two subclavian arteries, two internal mammary arteries, two aortic arch, and five major central venous injuries. Four patients had an associated lung injury with AIS >3, of which two suffered a pulmonary hilar vessel disruption. REBOA-related complications included one case of upper gastrointestinal bleeding. Six out of the seven patients survived the 30-day follow-up. No adverse neurologic outcomes or deficits were observed in survivors.
The combined use of REBOA and median sternotomy could be a feasible and effective alternative to hemorrhage control in patients with non-compressible torso hemorrhage secondary to penetrating chest trauma. These findings challenge the recommendation against the use of REBOA in penetrating intrathoracic injuries. Future studies with stronger designs and larger sample sizes are required to confirm our results.
Therapeutic, level V.
最近的证据表明，主动脉腔内球囊阻断复苏（REBOA）在严重躯干创伤患者中是一种有效的救生干预措施。然而，REBOA 在孤立性穿透性胸部损伤患者中的应用仍存在争议。我们建议在出现血流动力学不稳定的穿透性胸部创伤患者中，同时进行正中切开术和 REBOA，作为控制出血的可行且有效的方法。本研究的目的是介绍我们在这方面的初步经验。
我们前瞻性地收集了 2015 年 1 月至 2016 年 12 月期间在一级创伤中心使用 10Fr REBOA 并同时进行正中切开术的病例系列。我们纳入了血流动力学不稳定、无法按压的躯干出血合并穿透性胸部创伤的患者，这些患者在术中进行了 REBOA 部署和正中切开术。
在研究期间，我院共进行了 68 例与创伤相关的紧急开胸手术。其中 7 例患有穿透性胸部创伤和无法按压的躯干出血，并进行了 REBOA 加正中切开术。7 例患者中有 6 例存在胸内血管损伤：2 例锁骨下动脉、2 例内乳动脉、2 例主动脉弓和 5 例主要中心静脉损伤。4 例患者有肺损伤，AIS >3，其中 2 例肺门血管破裂。REBOA 相关并发症包括 1 例上消化道出血。7 例患者中有 6 例在 30 天随访时存活。幸存者未出现不良神经结局或缺陷。
REBOA 和正中切开术联合使用可能是控制穿透性胸部创伤引起的不可按压躯干出血的一种可行且有效的方法。这些发现对不建议在穿透性胸部损伤中使用 REBOA 的建议提出了挑战。需要进行设计更强、样本量更大的未来研究来证实我们的结果。
治疗性，5 级。
