Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland Medical Center, Baltimore, Maryland.
J Surg Res. 2020 Dec;256:149-155. doi: 10.1016/j.jss.2020.06.034. Epub 2020 Jul 21.
The aim of this study was to determine the current utilization patterns of resuscitative endovascular balloon occlusion of aorta (REBOA) for hemorrhage control in nontrauma patients.
Data on REBOA use in nontrauma emergency general surgery patients from six centers, 2014-2019, was pooled for analysis. We performed descriptive analyses using Fisher's exact, Student's t, chi-squared, or Mann-Whitney U tests as appropriate.
Thirty-seven patients with acute hemorrhage from nontrauma sources were identified. REBOA placement was primarily performed by trauma attendings (20/37, 54%) and vascular attendings (13/37, 35%). In seven patients (19%), balloons were positioned prophylactically but never inflated. In 24 (65%) of 37 patients, REBOA was placed in the operating room. 28/37 balloons (76%) were advanced to zone 1, 8/37 (22%) were advanced to zone 3, and there was one REBOA use in the inferior vena cava. Most common indications were gastrointestinal and peripartum bleeding. In the 30 cases of balloon inflation, 24 of 30 (80%) resulted in improved hemodynamics. Eleven of 30 patients (37%) died before discharge. One patient developed a distal embolism, but there were no reports of limb loss. Twelve patients (40% of all REBOA inflations and 63% of survivors) were discharged to home.
REBOA has been used in a range of acutely hemorrhaging emergency general surgery patients with low rates of access-related complications. Mortality is high in this patient population and further research is needed; however, appropriate patient selection and early use may improve survival in these life-threatening cases.
本研究旨在确定目前在非创伤患者中使用主动脉球囊阻断复苏术（REBOA）控制出血的情况。
对 2014 年至 2019 年六个中心的非创伤性急诊普通外科患者使用 REBOA 的数据进行了汇总分析。我们使用 Fisher 精确检验、Student t 检验、卡方检验或 Mann-Whitney U 检验进行描述性分析，具体取决于数据类型。
确定了 37 例非创伤性来源急性出血患者。REBOA 放置主要由创伤主治医生（20/37，54%）和血管主治医生（13/37，35%）完成。在 7 例患者（19%）中，球囊预防性放置但未充气。在 37 例患者中，有 24 例（65%）在手术室中放置了 REBOA。28/37 个球囊（76%）推进至 1 区，8/37 个球囊（22%）推进至 3 区，1 例 REBOA 用于下腔静脉。最常见的适应症是胃肠道和围产期出血。在 30 例球囊充气中，24 例（80%）导致血流动力学改善。30 例患者中有 11 例（37%）在出院前死亡。1 例患者发生远端栓塞，但无肢体丧失报告。12 例患者（所有 REBOA 充气患者的 40%和幸存者的 63%）出院回家。
REBOA 已用于多种急性出血性急诊普通外科患者，其血管通路相关并发症发生率较低。在这一患者群体中，死亡率较高，需要进一步研究；然而，适当的患者选择和早期使用可能会改善这些危及生命的情况下的生存率。
