Division of Trauma, University of California Davis Medical Center, Acute Care, and General Surgery Sacramento, CA.
Division of Trauma, University of California Davis Medical Center, Acute Care, and General Surgery Sacramento, CA.
J Surg Res. 2020 Sep;253:18-25. doi: 10.1016/j.jss.2020.03.027. Epub 2020 Apr 17.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular adjunct to hemorrhage control. Success relies on institutional support and focused training in arterial access. We hypothesized that hospitals with higher REBOA volumes will be more successful than low-volume hospitals at aortic occlusion with REBOA.
This is a retrospective study from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Registry from November 2013 to January 2018. Patients aged ≥18 y who underwent REBOA were included. Successful placement of REBOA catheters (defined as hemodynamic improvement with balloon inflation) was compared between high-volume (≥80 cases; two hospitals), mid-volume (10-20 cases; four hospitals), and low-volume (<10 cases; 14 hospitals) hospitals, adjusting for patient factors.
Of 271 patients from 20 hospitals, 210 patients (77.5%) had successful REBOA placement. Most patients were male (76.0%) and sustained blunt trauma (78.1%). cardiopulmonary resuscitation (CPR) was ongoing at the time of REBOA placement in 34.5% of patients. Inpatient mortality was 67.4%, unchanged by hospital volume. Multivariable logistic regression found increased odds of successful REBOA placement at high-volume versus low-volume hospitals (odds ratio [OR], 7.50; 95% confidence interval [CI], 2.10-27.29; P = 0.002) and mid-volume versus low-volume hospitals (OR, 7.82; 95% CI, 1.52-40.31; P = 0.014) and decreased odds among patients undergoing CPR during REBOA placement (OR, 0.10; 95% CI, 0.03-0.34; P < 0.001) when adjusting for age, sex, mechanism of injury, prehospital CPR, CPR on admission, transfer status, hospital location of REBOA placement, Glasgow Coma Scale ≤ 13, and injury severity.
Hospitals with higher REBOA volumes were more likely to achieve hemodynamic improvement with REBOA inflation. However, mortality and complication rates were unchanged. Independent of hospital volume, ongoing CPR is associated with a decreased odds of successful REBOA placement.
主动脉球囊阻断复苏术（REBOA）是一种控制出血的血管内辅助手段。其成功取决于机构支持和对动脉入路的集中培训。我们假设，主动脉球囊阻断复苏术（REBOA）量较高的医院在使用 REBOA 进行主动脉阻断方面将比低容量医院更成功。
这是一项来自美国创伤外科学会主动脉阻断复苏术创伤和急性护理手术登记处的回顾性研究，时间为 2013 年 11 月至 2018 年 1 月。纳入接受 REBOA 的年龄≥18 岁的患者。比较高容量（≥80 例；2 家医院）、中容量（10-20 例；4 家医院）和低容量（<10 例；14 家医院）医院中成功放置 REBOA 导管（定义为球囊充气后血流动力学改善）的情况，同时调整患者因素。
在 20 家医院的 271 名患者中，210 名患者（77.5%）成功放置了 REBOA。大多数患者为男性（76.0%），并遭受钝性创伤（78.1%）。在 34.5%的患者中，REBOA 放置时正在进行心肺复苏（CPR）。医院容量对住院死亡率无影响，仍为 67.4%。多变量逻辑回归发现，与低容量医院相比，高容量医院（优势比[OR]，7.50；95%置信区间[CI]，2.10-27.29；P=0.002）和中容量医院（OR，7.82；95%CI，1.52-40.31；P=0.014）成功放置 REBOA 的可能性更高，而在 REBOA 放置过程中接受 CPR 的患者（OR，0.10；95%CI，0.03-0.34；P<0.001）的可能性更低。
主动脉球囊阻断复苏术（REBOA）量较高的医院更有可能通过 REBOA 充气实现血流动力学改善。然而，死亡率和并发症发生率没有变化。无论医院容量如何，持续的心肺复苏（CPR）与成功放置 REBOA 的可能性降低有关。
