Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA.
Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA, USA.
Am Surg. 2020 Oct;86(10):1418-1423. doi: 10.1177/0003134820964496. Epub 2020 Oct 25.
For trauma patients with noncompressible truncal hemorrhage (NCTH), aortic occlusion (AO) is attempted with either resuscitative thoracotomy (RT) or the resuscitative endovascular balloon occlusion of the aorta (REBOA). However, it is often challenging to identify the group of patients who would benefit from AO procedures. We hypothesized that patients who met simple clinical criteria would have better outcomes following AO procedures. This is a retrospective cohort study using the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database (November 2013-August 2019) which included patients who arrived with signs of life and underwent AO procedures (RT or zone 1 REBOA). Outcomes were compared between patients who met the criteria (admission vital signs: Glasgow Coma Scale (GCS) ≥9 and systolic blood pressure <90 mm Hg) and those who did not. Subgroup analyses were then conducted on patients who had a REBOA placed and those who underwent RT. A total of 998 patients met our inclusion criteria. Of those, a REBOA was placed in 364 patients (37%), while 634 (64%) underwent RT. The overall mortality rate in the criteria (+) group was significantly lower than that in the criteria (-) group (62 vs. 79%, < .001). In patients who survived beyond the emergency department following AO procedures, those who met the criteria underwent hemorrhage control procedures more frequently (83% vs. 57%, < .001). Our data suggest that simple clinical criteria could guide the provider for proceeding with AO in patients with suspected NCTH.
对于非压迫性躯干出血（NCTH）的创伤患者，尝试通过复苏性开胸术（RT）或主动脉腔内球囊阻断复苏术（REBOA）进行主动脉闭塞（AO）。然而，通常很难确定哪些患者将从 AO 手术中获益。我们假设符合简单临床标准的患者在接受 AO 手术后会有更好的结果。这是一项回顾性队列研究，使用了主动脉闭塞复苏创伤和急性护理手术数据库（2013 年 11 月至 2019 年 8 月），该数据库包括有生命体征并接受 AO 手术（RT 或 1 区 REBOA）的患者。将符合标准（入院生命体征：格拉斯哥昏迷量表（GCS）≥9 且收缩压＜90mmHg）和不符合标准的患者的结果进行了比较。然后对接受 REBOA 置管和接受 RT 的患者进行了亚组分析。共有 998 名患者符合我们的纳入标准。其中，364 名患者（37%）接受了 REBOA 置管，634 名患者（64%）接受了 RT。符合标准（+）组的总体死亡率明显低于不符合标准（-）组（62%比 79%，<.001）。在接受 AO 手术后在急诊科存活的患者中，符合标准的患者更频繁地进行出血控制手术（83%比 57%，<.001）。我们的数据表明，简单的临床标准可以指导医生在疑似 NCTH 的患者中进行 AO。
