主动脉腔内球囊反搏在伴大出血的穿透性胸部创伤中是可行的：提出一种新的机构部署算法。
Resuscitative endovascular balloon of the aorta is feasible in penetrating chest trauma with major hemorrhage: Proposal of a new institutional deployment algorithm.
机构信息
From the Division of Trauma and Acute Care Surgery, Department of Surgery, (C.A.O., F.R., J.J.S., A.S., A.M.d.V., A.G.), Fundación Valle del Lili, Cali, Colombia; Seccion de Cirugía de Trauma y Emergencias (C.A.O., F.R., J.J.S., A.S., J.J.M., E.A., A.G.), Universidad del Valle-Hospital Universitario del Valle, Cali, Colombia; Department of Trauma Critical Care (M.P.), Broward General Level I Trauma Center, Fort Lauderdale, Florida; Center for Surgery and Public Health, Department of Surgery (J.P.H., C.O.), Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Centro de Investigaciones Clínicas (CIC) (M.G.-R., E.Y.C.), Fundación Valle del Lili, Cali, Colombia; and Department of Surgery (M.B.), Riverside University Health Systems, University of California, Riverside, California.
出版信息
J Trauma Acute Care Surg. 2020 Aug;89(2):311-319. doi: 10.1097/TA.0000000000002773.
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging option for hemorrhage control, but its use is limited in scenarios such as penetrating chest trauma. The aim of this study was to describe the use of REBOA as a resuscitative adjunct in these cases with major hemorrhage and to propose a new clinical management algorithm.
METHODS
This was a prospective, observational study conducted at a single Level I trauma center in Colombia. We included all patients older than 14 years with severe trauma who underwent REBOA from January 2015 to December 2019. Patients received REBOA if they were in hemorrhagic shock and were unresponsive to resuscitation.
RESULTS
A total of 56 patients underwent REBOA placement of which 37 had penetrating trauma and 23 had chest trauma. All patients were hemodynamically unstable upon arrival to the emergency department, with a median systolic blood pressure of 69 mm Hg (interquartile range [IQR], 57-90 mm Hg) and median Injury Severity Score was 25 (IQR, 25-41). All REBOAs were deployed and inflated in zone 1, median inflation time was 40 minutes (IQR, 26-55 minutes), and no adverse neurologic outcomes were observed. Fifteen patients had REBOA and a median sternotomy. Eleven patients had concomitant abdominal wounds. Overall mortality was 28.6%, and there was no significant difference between penetrating versus blunt trauma patients (21.6% vs. 42.1%, p = 0.11). The survival rate of thoracic injured patients was similar to the predicted survival (65.2% vs. 63.3%).
CONCLUSION
Resuscitative endovascular balloon occlusion of the aorta can be used safely in penetrating chest trauma, and the implementation of a REBOA management algorithm is feasible with a well-trained multidisciplinary team.
LEVEL OF EVIDENCE
Therapeutic, level V.
背景
主动脉球囊阻断复苏术（REBOA）是一种新兴的控制出血的方法，但在穿透性胸部创伤等情况下其应用受到限制。本研究旨在描述在这些大出血情况下使用 REBOA 作为复苏辅助手段，并提出一种新的临床管理算法。
方法
这是一项在哥伦比亚的一家一级创伤中心进行的前瞻性观察性研究。我们纳入了所有在 2015 年 1 月至 2019 年 12 月期间接受 REBOA 的年龄大于 14 岁的严重创伤患者。如果患者有出血性休克且对复苏无反应，则接受 REBOA。
结果
共 56 例患者接受了 REBOA 置管，其中 37 例为穿透性创伤，23 例为胸部创伤。所有患者到达急诊科时均存在血流动力学不稳定，中位收缩压为 69mmHg（四分位距 [IQR]，57-90mmHg），损伤严重程度评分中位数为 25（IQR，25-41）。所有 REBOA 均在 1 区放置和充气，中位充气时间为 40 分钟（IQR，26-55 分钟），未观察到不良神经学结局。15 例患者行 REBOA 和正中开胸术，11 例患者合并腹部伤口。总体死亡率为 28.6%，穿透性和钝性创伤患者之间无显著差异（21.6%比 42.1%，p=0.11）。胸部损伤患者的存活率与预测存活率相似（65.2%比 63.3%）。
结论
在穿透性胸部创伤中，主动脉球囊阻断复苏术可以安全使用，且在经过良好培训的多学科团队实施 REBOA 管理算法是可行的。
证据等级
治疗，5 级。
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