García Alberto F, Manzano-Nunez Ramiro, Orlas Claudia P, Ruiz-Yucuma Juan, Londoño Alejandra, Salazar Camilo, Melendez Juan, Sánchez Álvaro I, Puyana Juan Carlos, Ordoñez Carlos A
Fundacion Valle del Lili University Hospital, Clinical Research Center, Cali, Colombia.
Department of Surgery, Universidad del Valle, Cali, Colombia.
Eur J Trauma Emerg Surg. 2021 Dec;47(6):1779-1785. doi: 10.1007/s00068-020-01370-9. Epub 2020 Apr 16.
The purpose of this study was to examine the association of REBOA and mortality in a group of patients with penetrating trauma to the torso, treated in a level-I trauma center from Colombia.
In a retrospective cohort study, patients with penetrating trauma, requiring emergency surgery, and treated between 2014 and 2018, were included. The decision to use or not use REBOA during emergent surgery was based on individual surgeon's opinion. A propensity score (PS) was calculated after adjusting for age, clinical signs on admission (systolic blood pressure, cardiac rate, Glasgow coma scale), severe trauma in thorax and abdomen, and the presence of non-compressive torso hemorrhage. Subsequently, logistic regression for mortality was adjusted for the number of red blood cells (RBC) transfused within the first six hours after admission, injury severity score (ISS), and quintiles of PS.
We included 345 patients; 28 of them (8.1%) were treated with REBOA. Crude mortality rates were 17.9% (5 patients) in REBOA group and 15.3% (48 patients) in control group (p = 0.7). After controlling for RBC transfused, ISS, and the PS, the odds of death in REBOA group was 78% lower than that in the control group (odds ratio [OR] 0.20, 95% confidence interval [95%CI] 0.05-0.77, p = 0.01).
We found that, when compared to no REBOA use, patients treated with REBOA had lower risk-adjusted odds of mortality. These findings should be interpreted with caution and confirmed in future comparative studies, if possible.
本研究旨在探讨在哥伦比亚一家一级创伤中心接受治疗的一组躯干穿透伤患者中，主动脉内球囊阻断术（REBOA）与死亡率之间的关联。
在一项回顾性队列研究中，纳入了2014年至2018年间因穿透伤需要急诊手术治疗的患者。急诊手术期间是否使用REBOA的决定基于外科医生的个人意见。在对年龄、入院时的临床体征（收缩压、心率、格拉斯哥昏迷量表）、胸部和腹部严重创伤以及非压迫性躯干出血的存在进行调整后，计算倾向评分（PS）。随后，针对入院后前6小时内输注的红细胞（RBC）数量、损伤严重程度评分（ISS）和PS五分位数对死亡率进行逻辑回归调整。
我们纳入了345例患者；其中28例（8.1%）接受了REBOA治疗。REBOA组的粗死亡率为17.9%（5例患者），对照组为15.3%（48例患者）（p = 0.7）。在对输注的RBC、ISS和PS进行控制后，REBOA组的死亡几率比对照组低78%（优势比[OR] 0.20，95%置信区间[95%CI] 0.05 - 0.77，p = 0.01）。
我们发现，与未使用REBOA相比，接受REBOA治疗的患者经风险调整后的死亡几率更低。这些发现应谨慎解读，如有可能，需在未来的比较研究中得到证实。
