Teeter William A, Bradley Matthew J, Romagnoli Anna, Hu Peter, Li Yao, Stein Deborah M, Scalea Thomas M, Brenner Megan
R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
Am Surg. 2018 Oct 1;84(10):1691-1695.
The purpose of this study is to compare end-tidal carbon dioxide (EtCO₂) during resuscitation of open-chest cardiac massage (OCCM) with aortic cross-clamp (ACC) receiving resuscitative endovascular balloon occlusion of the aorta (REBOA) with closed-chest compressions (CCCs). Patients who received REBOA were compared with patients receiving OCCM for traumatic arrest using continuous vital sign monitoring and videography. Thirty-three patients were enrolled in the REBOA group and 18 patients were enrolled in the OCCM group. Of the total patients, 86.3 per cent were male with a mean age of 36.2 ± 13.9 years. Ninety-four percent of patients suffered penetrating trauma in the OCCM group compared with 30.3 per cent of the REBOA group ( = <0.001). Before aortic occlusion (AO), there was no difference in initial EtCO₂ values, but mean, median, peak, and final EtCO₂ values were lower in OCCM ( < 0.005). During CPR after AO, the initial, mean, and median values were higher with REBOA ( = 0.015, 0.036, and 0.038). The rate of return of spontaneous circulation was higher in REBOA OCCM (20/33 [60.1%] 5/18 [33.3%]; = 0.04), and REBOA patients survived to operative intervention more frequently ( = 0.038). REBOA patients had greater total cardiac compression fraction (CCF) before AO than OCCM (85.3 ± 12.7% 35.2 ± 18.6%, < 0.0001) and after AO (88.3 ± 7.8% 71.9 ± 24.4%, = 0.0052). REBOA patients have higher EtCO₂ and cardiac compression fraction before and after AO compared with patients who receive OCCM.
本研究的目的是比较在接受复苏性血管内主动脉球囊阻断术（REBOA）的开胸心脏按压（OCCM）并进行主动脉交叉钳夹（ACC）与闭胸按压（CCC）复苏期间的呼气末二氧化碳（EtCO₂）情况。通过持续生命体征监测和摄像，将接受REBOA的患者与因创伤性心脏骤停接受OCCM的患者进行比较。REBOA组纳入33例患者，OCCM组纳入18例患者。在所有患者中，86.3%为男性，平均年龄为36.2±13.9岁。OCCM组94%的患者遭受穿透性创伤，而REBOA组为30.3%（P<0.001）。在主动脉阻断（AO）前，初始EtCO₂值无差异，但OCCM组的平均、中位数、峰值和最终EtCO₂值较低（P<0.005）。在AO后的心肺复苏期间，REBOA组的初始、平均和中位数EtCO₂值较高（P分别为0.015、0.036和0.038）。REBOA组自主循环恢复率高于OCCM组（20/33[60.1%]对5/18[33.3%]；P=0.04），且REBOA组患者更频繁地存活至手术干预（P=0.038）。REBOA组患者在AO前的总心脏按压分数（CCF）高于OCCM组（85.3±12.7%对35.2±18.6%，P<0.0001），AO后也是如此（88.3±7.8%对71.9±24.4%，P=0.0052）。与接受OCCM的患者相比，REBOA组患者在AO前后的EtCO₂和心脏按压分数更高。
