Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost BG-Klinikum Halle gGmbH, Merseburgerstr. 165, 06112, Halle, Germany.
Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
World J Emerg Surg. 2020 Mar 30;15(1):23. doi: 10.1186/s13017-020-00301-8.
Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR.
Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate.
Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to the hospital with ongoing CPR. Nine patients (35%) died within the first 24 h, while seventeen patients (65%) survived post 24 h. The survival rate to hospital discharge was 27% (n = 7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p = 0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. The survival rate in the 16 patients responding to REBOA was 37.5% (n = 6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from the median (range) 56.5 (0-147) to 90 (0-200) mmHg.
Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated.
遭受创伤性心脏骤停（TCA）并需要心肺复苏（CPR）的严重受伤创伤患者很少存活。在 TCA 后早期接受经皮主动脉球囊阻断术（REBOA）的 TCA 患者的作用尚未明确。随着 REBOA 的应用增加，人们非常关注 TCA 后早期使用 REBOA 是否与生存获益相关。利用来自 ABOTrauma 登记处的数据，我们旨在研究在需要院前 CPR 的创伤患者中，在入院后早期使用 REBOA 的作用。
2014 年至 2019 年，在全球 7 个国家的 11 个中心，从 ABOTrauma 登记处中收集关于 REBOA 使用的回顾性和前瞻性数据。在所有院前 TCA 的患者中，使用修订后的创伤严重程度分类 II（RISC II）预测的生存率与观察到的生存率进行比较。
ABOTrauma 登记处共有 213 例患者，其中确定了 26 例（12.2%）接受过院前 CPR 的患者。中位（范围）损伤严重程度评分（ISS）为 45.5（25-75）。14 例（54%）患者在入院时正在接受 CPR。9 例（35%）患者在 24 小时内死亡，而 17 例（65%）患者在 24 小时后存活。出院时的存活率为 27%（n=7）。使用 RISC II 预测的死亡率为 0.977（26 例中的 25 例）。观察到的死亡率（26 例中的 19 例）明显低于预测死亡率（p=0.049）。对 REBOA 无反应的患者更有可能死亡。仅 10 例无反应者中的 1 例（10%）存活。对 REBOA 有反应的 16 例患者的生存率为 37.5%（n=6）。REBOA 的中位（范围）持续时间为 45（8-70）分钟，可将中位（范围）血压从 56.5（0-147）mmHg 显著升高至 90（0-200）mmHg。
在入院后早期接受 REBOA 的 TCA 患者的死亡率明显低于 RISC II 预测的死亡率。REBOA 可能会改善 TCA 后的生存率。应进一步研究这些患者使用 REBOA。
