Department of Anesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital Halle, Mersbuegerstraße 165, 06112, Halle (Saale), Germany.
Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
World J Emerg Surg. 2020 Nov 23;15(1):62. doi: 10.1186/s13017-020-00342-z.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about "Who is and who should be performing it?"
Data from the international ABO (aortic balloon occlusion) Trauma Registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how, and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients.
During the study period, 259 patients had been recorded in the registry, 72.5% (n = 188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5%, and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common femoral artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cutdown in 57 patients (24%), using ultrasound in 49 patients (21%), and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient's age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room, and mortality.
A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cutdown is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing "Who should be performing REBOA?" future research should focus on "Which patient benefits most from REBOA?"
主动脉球囊阻断复苏术（REBOA）是一种微创技术，越来越多地用于防止非压缩性躯干出血的患者失血过多。REBOA 的广泛应用引发了关于“谁来做以及谁应该做 REBOA？”的讨论。
对 2014 年 11 月至 2020 年 4 月期间国际 ABO（主动脉球囊阻断）创伤登记处的数据进行分析，探讨了以下问题：REBOA 是由谁、如何以及在哪里进行的？该登记处收集了有关创伤患者使用 REBOA 的回顾性和前瞻性数据。
在研究期间，该登记处共记录了 259 名患者，其中 72.5%（n=188）为男性，中位（范围）年龄为 46（10-96）岁。REBOA 在急诊室进行 50.5%，在手术室进行 41.5%，在血管造影室进行 8%。在 54%的患者中，REBOA 由外科医生（创伤外科医生 28%，血管外科医生 22%，普通外科医生 4%）进行，在 46%的患者中由非外科医生（急诊医生 31%，放射科医生 9.5%，麻醉师 5.5%）进行。119 名患者（51%）采用股动脉（CFA）外部解剖标志和触诊，57 名患者（24%）采用切开，49 名患者（21%）采用超声，9 名患者（4%）采用透视。外科医生和非外科医生在患者年龄、损伤严重程度、入路方法、REBOA 实施地点、从急诊室转至的地点以及死亡率方面存在显著差异。
相当数量的外科和非外科医学专业都在成功地进行 REBOA，而且程度几乎相同。与旧文献中的报道相比，CFA 的入路较少采用外科切开，而单纯采用外部解剖标志和触诊进行穿刺的成功率较高。未来的研究不应再讨论“谁应该进行 REBOA？”，而应关注“哪些患者从 REBOA 中获益最大？”
