From the Department of Surgery (J.M.S., J.R.C.), University of Colorado Anschutz, Aurora, Colorado; Department of Surgery (K.S., J.N.M.), University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska; Department of Surgery (E.E.M., C.J.F., M.J.C.), Denver Health Medical Center; and Department of Public Health and Surgery (A.S.), University of Colorado Denver, Denver, Colorado.
J Trauma Acute Care Surg. 2020 Oct;89(4):e112-e116. doi: 10.1097/TA.0000000000002855.
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) was first described in the 1950s, but early attempts at REBOA faced several technical challenges. Subsequent advances in endovascular technologies led to renewed interest in employing REBOA for management of hemorrhagic shock. However, REBOA usage remains infrequent, and indications for REBOA implementation remain unclear. We evaluated current opinions of trauma surgeons toward the use of REBOA for control of trauma-related hemorrhage and other causes of hemorrhagic shock. We hypothesize, that despite heightened interest in REBOA, implementation remains limited. A 25-question survey was thus created to query institutional and surgeon-specific training and practice patterns related to REBOA usage. The anonymized survey was distributed via email to a national trauma surgeon database and responses were recorded online. 992 subjects were invited to participate, of whom 31% (n=311) responded. Of these, 89% reported to be a trauma or acute care surgeon at a Level I trauma center, 50% reported practicing for ≥20 years. Two-thirds (68%) reported REBOA use at their institution, and the majority (59%) employed REBOA at least once. However, most (78%) performed ≤5 REBOA placements last year. Respondents supported REBOA usage in non-trauma causes of shock including gastrointestinal bleeding (60%), post-partum hemorrhage (83%), and ruptured abdominal aortic aneurysm (69%). A significant minority (20.3%) reported either only slight confidence or no confidence in their ability to deploy REBOA, and thus 21% reported being ‘very interested’ in attending a REBOA skills course.We thus conclude that REBOA has gained wide interest among trauma surgeons. However, placement remains infrequent with most providers placing a few annually. Educational courses are needed to disseminate the necessary skills for REBOA utilization.
主动脉球囊阻断复苏术（REBOA）最早于 20 世纪 50 年代被描述，但早期的 REBOA 尝试面临着几个技术挑战。随后，血管内技术的进步重新引起了人们对 REBOA 用于治疗失血性休克的兴趣。然而，REBOA 的使用仍然很少，REBOA 的实施指征也不清楚。我们评估了创伤外科医生对 REBOA 用于控制创伤相关出血和其他原因引起的失血性休克的看法。我们假设，尽管对 REBOA 的兴趣增加了，但实施仍然有限。因此，我们创建了一个 25 个问题的调查，以询问与 REBOA 使用相关的机构和外科医生特定的培训和实践模式。匿名调查通过电子邮件分发给全国创伤外科医生数据库，在线记录回复。邀请了 992 名受试者参加，其中 31%（n=311）做出了回应。其中，89%的人报告在一级创伤中心担任创伤或急性护理外科医生，50%的人报告有≥20 年的从业经验。三分之二（68%）的人报告在其机构使用 REBOA，大多数（59%）人至少使用过一次。然而，大多数（78%）人去年仅进行了≤5 次 REBOA 放置。受访者支持在非创伤性休克原因中使用 REBOA，包括胃肠道出血（60%）、产后出血（83%）和腹主动脉瘤破裂（69%）。一小部分（20.3%）受访者表示对部署 REBOA 的能力只有轻微信心或没有信心，因此 21%的人表示对参加 REBOA 技能课程非常感兴趣。因此，我们得出结论，REBOA 在创伤外科医生中得到了广泛的关注。然而，放置仍然很少见，大多数提供者每年只放置几次。需要教育课程来传播 REBOA 使用所需的技能。
