Vella Michael A, Dumas Ryan Peter, DuBose Joseph, Morrison Jonathan, Scalea Thomas, Moore Laura, Podbielski Jeanette, Inaba Kenji, Piccinini Alice, Kauvar David S, Baggenstoss Valorie L, Spalding Chance, Fox Charles, Moore Ernest E, Cannon Jeremy W
Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Trauma Surg Acute Care Open. 2019 Nov 11;4(1):e000340. doi: 10.1136/tsaco-2019-000340. eCollection 2019.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality.
The American Association for the Surgery of Trauma AORTA registry was used to identify patients undergoing REBOA. Injury characteristics and outcomes data were compared between OR and ED groups. The primary outcome was in-hospital mortality; secondary outcomes included total AO time, transfusion requirements, and acute kidney injury.
Location and timing of catheter insertion were available for 305 of 321 (95%) subjects. 58 patients underwent REBOA in the OR (19%). There were no differences with respect to sex, admission lactate, and Injury Severity Score. The OR group was younger (33 years vs. 41 years, p=0.01) and with more penetrating injuries (36% vs. 15%, p<0.001). There were significant differences with respect to admission physiology. Time from admission to AO was longer in the OR group (75 minutes vs. 23 minutes, p<0.001) as was time to definitive hemostasis (116 minutes vs. 79 minutes, p=0.01). Unadjusted mortality was lower in the OR group (36.2% vs. 68.8%, p<0.001). There were no differences in secondary outcomes. After controlling for covariates, there was no association between insertion location and in-hospital mortality (OR 1.8, 95% CI 0.30 to 11.50).
OR REBOA placement is common and generally employed in patients with more stable admission physiology. OR placement was not associated with increased in-hospital mortality despite longer times to AO and definite hemostasis when compared with catheters placed in the ED.
IV; therapeutic/care management.
复苏性血管内主动脉球囊阻断术（REBOA）是一种侵入性较小的主动脉阻断（AO）技术。该操作通常在急诊科（ED）进行，术中放置的作用尚不太明确。我们推测手术室（OR）放置与院内死亡率增加有关。
使用美国创伤外科协会主动脉登记处的数据来确定接受REBOA治疗的患者。比较手术室组和急诊科组的损伤特征及结局数据。主要结局是院内死亡率；次要结局包括总AO时间、输血需求和急性肾损伤。
321名受试者中的305名（95%）有导管插入位置和时间的数据。58名患者在手术室接受了REBOA治疗（19%）。两组在性别、入院时乳酸水平和损伤严重程度评分方面无差异。手术室组患者更年轻（33岁对41岁，p = 0.01），穿透伤更多（36%对15%，p < 0.001）。入院时生理状况存在显著差异。手术室组从入院到AO的时间更长（75分钟对23分钟，p < 0.001），确定性止血时间也更长（116分钟对79分钟，p = 0.01）。未调整的死亡率在手术室组较低（36.2%对68.8%，p < 0.001）。次要结局方面无差异。在控制协变量后，插入位置与院内死亡率之间无关联（比值比1.8，95%置信区间0.30至11.50）。
手术室放置REBOA很常见，通常用于入院时生理状况较稳定的患者。与在急诊科放置导管相比，尽管手术室放置到AO和确定性止血的时间更长，但并未导致院内死亡率增加。
IV；治疗/护理管理。
