From the Departments of Surgery and Clinical Investigations (W.S.D., D.M.R., R.R.S., J.B.W., M.R.B., K.K.S., G.E.B., S.R.H., M.J.E., M.J.M.), Madigan Army Medical Center, Tacoma, Washington; and Trauma and Emergency Surgery Service (M.J.M.), Legacy Emanuel Medical Center, Portland, Oregon.
J Trauma Acute Care Surg. 2019 Jul;87(1):18-26. doi: 10.1097/TA.0000000000002266.
The objective of this study was to compare the efficacy of preperitoneal balloon tamponade (PPB), resuscitative endovascular balloon occlusion of the orta (REBOA), and open preperitoneal packing (OP) in a realistic animal model of pelvic fracture-associated hemorrhage.
Thirty-nine swine underwent creation of open-book pelvic fracture and iliac vascular injury. Animals were randomized to no intervention (n = 7), OP (n = 10), PPB (n = 9), zone 1 REBOA (n = 7), and zone 3 REBOA (n = 6) at a mean arterial pressure less than 40 mm Hg from uncontrolled hemorrhage. Primary outcome was survival at 1 hour. Secondary outcomes included survival in the immediate 10 m following intervention reversal, peak preperitoneal pressure (PP), blood loss, bleed rate, and peak lactate.
Prior to injury, no difference was measured between groups for weight, hemodynamics, lactate, and hematocrit (all p = NS). The injury was uniformly lethal without intervention, with survival time (mean) of 5 m, peak PP of 14 mm Hg, blood loss of 960 g, bleed rate of 450 g/m, and peak lactate of 2.6 mmol/L. Survival time (m) was extended to 44 with OP, 60 with PPB, and 60 with REBOA (p < 0.01). Peak PP (mm Hg) was 19 with OP, 23 with PPB, 10 with zone 1 REBOA, and 6 with zone 3 REBOA (p < 0.05). Blood loss (g) was 850 with OP, 930 with PPB, 610 with zone 1 REBOA, and 370 with zone 3 REBOA (p < 0.01). Peak lactate (mmol/L) was 3.3 with OP, 4.3 with PPB, 13.4 with zone 1 REBOA, and 5.3 with zone 3 REBOA (p < 0.01). Only 33% of zone 1 REBOA animals survived the initial 10 m after balloon deflation, compared to 60% for OP, 67% for PPB, and 100% for zone 3 REBOA (p < 0.01).
Preperitoneal balloon tamponade and zone 3 REBOA are effective alternatives to OP in this animal model of lethal pelvic fracture-associated hemorrhage. Zone 1 REBOA extends survival time but with high mortality upon reversal.
本研究旨在比较经腹膜前球囊填塞（PPB）、复苏性血管内球囊阻断主动脉（REBOA）和开放性腹膜前填塞（OP）在骨盆骨折相关出血的现实动物模型中的疗效。
39 头猪接受开放性骨盆骨折和髂血管损伤的治疗。动物随机分为无干预（n = 7）、OP（n = 10）、PPB（n = 9）、区域 1 REBOA（n = 7）和区域 3 REBOA（n = 6），平均动脉压低于 40mmHg 时出现不受控制的出血。主要结局为 1 小时内的生存率。次要结局包括干预逆转后 10m 内的即刻生存率、腹膜前压峰值（PP）、失血量、出血率和血乳酸峰值。
在受伤前，各组之间的体重、血流动力学、乳酸和血细胞比容无差异（均 p = NS）。没有干预的情况下，损伤是一致致命的，无干预组的存活时间（平均）为 5m，腹膜前压峰值为 14mmHg，失血量为 960g，出血率为 450g/m，血乳酸峰值为 2.6mmol/L。OP 的存活时间（m）延长至 44，PPB 延长至 60，REBOA 延长至 60（p < 0.01）。OP 的 PP 峰值（mmHg）为 19，PPB 为 23，区域 1 REBOA 为 10，区域 3 REBOA 为 6（p < 0.05）。OP 的失血量（g）为 850，PPB 为 930，区域 1 REBOA 为 610，区域 3 REBOA 为 370（p < 0.01）。OP 的血乳酸峰值（mmol/L）为 3.3，PPB 为 4.3，区域 1 REBOA 为 13.4，区域 3 REBOA 为 5.3（p < 0.01）。只有 33%的区域 1 REBOA 动物在球囊放气后的最初 10m 内存活，而 OP 为 60%，PPB 为 67%，区域 3 REBOA 为 100%（p < 0.01）。
在这种致命性骨盆骨折相关出血的动物模型中，经腹膜前球囊填塞和区域 3 REBOA 是 OP 的有效替代方法。区域 1 REBOA 延长了生存时间，但逆转后死亡率很高。
