Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
Injury. 2020 Aug;51(8):1834-1839. doi: 10.1016/j.injury.2020.06.003. Epub 2020 Jun 6.
Early hemorrhage control after severe blunt pelvic trauma is life-saving. The aim of this study is to compare the efficacy and outcomes of pre-peritoneal packing (PPP) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) with a subsequent hemorrhage control procedure to control life-threatening pelvic hemorrhage in trauma patients.
A 3-year (2015-2017) retrospective analysis of the Trauma Quality Improvement Program (TQIP) was performed. All blunt trauma patients (aged ≥15 years) who underwent PPP or Zone 3 REBOA placement were included while deaths on arrival and transfers were excluded. Patients were matched on clinical characteristics using propensity score matching (PSM). Univariate analysis was performed to compare mortality, time to procedure, time in ED, transfusion requirements, complications rates, and ICU and hospital length of stay (LOS) amongst patient groups.
Of 420 trauma patients, 307 underwent PPP and 113 REBOA. Patients had similar hemodynamics and ISS upon presentation, but PPP patients had a higher GCS (P = 0.037) and more blunt kidney injuries (P = 0.015). After PSM, 206 trauma patients were included in the analysis. There were no significant differences in blood transfusion, LOS, or major complications. Time to REBOA was shorter than time to PPP (52 vs 77.5 min; P<0.001) with longer time in ED (65 vs 51 min; p = 0.023). The 24-hour (32.4 vs 17.7%; P = 0.23) and in-hospital mortality (52.0 vs 37.3%; P = 0.048) were higher after REBOA.
PPP is associated with improved survival compared to REBOA placement. Delay in definitive hemorrhage control may provide a potential explanation, but causation remains unresolved. This data suggests that early PPP may offer a benefit over REBOA in the setting of hemorrhage after blunt pelvic trauma. Further, large, multi-institutional studies are warranted to support these findings.
Prognostic study, level III.
严重钝性骨盆创伤后早期止血是救命的关键。本研究的目的是比较腹膜前填塞（PPP）和复苏性血管内球囊阻断主动脉（REBOA）的疗效和结果，以控制创伤患者危及生命的骨盆出血。
对创伤质量改进计划（TQIP）进行了为期 3 年（2015-2017 年）的回顾性分析。所有接受 PPP 或 Zone 3 REBOA 放置的钝性创伤患者（年龄≥15 岁）均被纳入研究，排除入院时死亡和转院的患者。采用倾向评分匹配（PSM）对患者进行临床特征匹配。采用单因素分析比较各组患者的死亡率、手术时间、急诊时间、输血需求、并发症发生率以及 ICU 和住院时间（LOS）。
在 420 例创伤患者中，307 例行 PPP，113 例行 REBOA。患者在就诊时的血流动力学和 ISS 相似，但 PPP 患者的 GCS 更高（P=0.037），钝性肾损伤更多（P=0.015）。PSM 后，206 例创伤患者纳入分析。输血、LOS 或主要并发症无显著差异。REBOA 时间短于 PPP（52 与 77.5 分钟；P<0.001），急诊时间长（65 与 51 分钟；P=0.023）。24 小时（32.4%与 17.7%；P=0.23）和住院死亡率（52.0%与 37.3%；P=0.048）更高。
与 REBOA 相比，PPP 与生存率的提高相关。确定性止血延迟可能是一个潜在的解释，但因果关系仍未解决。这些数据表明，在钝性骨盆创伤后出血的情况下，早期 PPP 可能优于 REBOA。此外，还需要进行大型多机构研究来支持这些发现。
预后研究，III 级。
