Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.
Department of Surgery, University of South Florida, Tampa, FL, USA.
Am Surg. 2022 Jun;88(6):1097-1103. doi: 10.1177/0003134820988813. Epub 2021 Jan 31.
Hemorrhage accounts for >30% of trauma-related mortalities. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for temporary hemostasis in the civilian population remains controversial. We aim to investigate REBOA practices through analysis of surgeon and trauma center characteristics, implementation, patient characteristics, and overall opinions.
An anonymous 30-question standardized online survey on REBOA use was administered to active trauma surgeon members of the Eastern Association for the Surgery of Trauma.
A total of 345 responses were received, and 130/345 (37.7%) reported REBOA being favorable, 42 (12.2%) reported REBOA unfavorably, and 173 (50.1%) were undecided. The majority of respondents (87.6%) reported REBOA performance in the trauma bay. 170 (49.3%) of respondents reported having deployed REBOA at least once over the past 2 years. 80.0% reported blunt trauma being the most common mechanism of injury in REBOA patients. Resuscitative endovascular balloon occlusion of the aorta deployment in zone 3 of the aorta was significantly higher in patients reported to suffer a pelvic fracture or pelvic hemorrhage, whereas REBOA deployment in zone 1 was significantly higher among patients reported to suffer hepatic, splenic, or other intra-abdominal hemorrhage ( < .05).
Among survey respondents, frequency of REBOA use was low along with knowledge of clear indications for use. While current REBOA usage among respondents appeared to model current guidelines, additional research regarding REBOA indications, ideal patient populations, and outcomes is needed in order to improve REBOA perception in trauma surgeons and increase frequency of use.
出血占创伤相关死亡人数的>30%。在平民中使用主动脉球囊阻断复苏（REBOA）进行临时止血仍然存在争议。我们旨在通过分析外科医生和创伤中心的特点、实施情况、患者特征以及总体意见来研究 REBOA 的应用。
对东部创伤外科学会的活跃创伤外科医生成员进行了一项关于 REBOA 使用的匿名 30 个问题的标准化在线调查。
共收到 345 份回复，其中 130/345（37.7%）表示 REBOA 有利，42/345（12.2%）表示 REBOA 不利，173/345（50.1%）表示不确定。大多数受访者（87.6%）表示在创伤室进行了 REBOA 操作。170（49.3%）名受访者报告在过去 2 年内至少进行过一次 REBOA 部署。80.0%的受访者报告称钝性创伤是 REBOA 患者最常见的损伤机制。在报告患有骨盆骨折或骨盆出血的患者中，主动脉球囊阻断复苏在主动脉区 3 区的部署明显更高，而在报告患有肝、脾或其他腹腔内出血的患者中，主动脉球囊阻断复苏在主动脉区 1 区的部署明显更高（<0.05）。
在调查受访者中，REBOA 的使用频率较低，同时对明确的使用指征的了解也有限。尽管目前受访者对 REBOA 的使用似乎符合当前的指南，但需要进一步研究 REBOA 的适应症、理想的患者人群和结果，以提高创伤外科医生对 REBOA 的认识并增加其使用频率。
