Department of Surgery, Kendall Regional Medical Center, Miami, FL.
Department of Surgery, Kendall Regional Medical Center, Miami, FL.
Surgery. 2021 Jul;170(1):284-290. doi: 10.1016/j.surg.2021.01.043. Epub 2021 Mar 4.
Hemorrhage remains a leading cause of death among trauma patients. Resuscitative endovascular balloon occlusion of the aorta has grown in popularity as an efficient, less invasive alternative to managing patients with noncompressible hemorrhage. The aim of this study to investigate the clinical outcomes of resuscitative endovascular balloon occlusion of the aorta use in adult civilian trauma patients with and without concomitant traumatic brain injury.
This a secondary analysis of the American College of Surgeons Trauma Quality Improvement Program database from the years 2015 to 2017 of adult trauma patients with and without traumatic brain injury and who had a resuscitative endovascular balloon occlusion of the aorta. Patients who were deceased on arrival, required resuscitative thoracotomy, or had missing information regarding traumatic brain injury status were excluded. Multivariable risk adjustment was performed. The primary outcome was inpatient mortality.
Of 2,352,542 patients, 199 met the criteria for inclusion in the final analysis. resuscitative endovascular balloon occlusion of the aorta + traumatic brain injury patients were significantly more likely to have a lower Glasgow Coma Scale ≤8 (82.4% vs 54.4%, P < .001) and systolic blood pressure (89 ± 37.4 vs 107.2 ± 39.7; P = .002), and higher injury severity score >25 (83.5% vs 65.8%, P = .01) compared with resuscitative endovascular balloon occlusion of the aorta/non-traumatic brain injury patients. No differences in odds of inpatient mortality (62.4% vs 50.9%, P = .11) or complications (17.7% vs 11.4%, P = .21) were observed between groups. Subgroup analysis based on mechanism of injury, trauma center level, teaching hospital status, and pelvic fracture status also did not show any differences in mortality.
Inpatient mortality with resuscitative endovascular balloon occlusion of the aorta use does not differ between patients with or without concomitant traumatic brain injury, despite those with traumatic brain injury having significantly higher injury severity and more severe hypotension on intake.
出血仍然是创伤患者死亡的主要原因。主动脉球囊阻断复苏术作为一种有效、微创的替代方法，在处理非压迫性出血患者方面越来越受欢迎。本研究旨在探讨主动脉球囊阻断复苏术在合并或不合并创伤性脑损伤的成人创伤患者中的临床效果。
这是对美国外科医师学院创伤质量改进计划数据库 2015 年至 2017 年期间合并或不合并创伤性脑损伤且接受主动脉球囊阻断复苏术的成人创伤患者的二次分析。排除入院时死亡、需要开胸复苏或创伤性脑损伤状态信息缺失的患者。进行多变量风险调整。主要结局为住院死亡率。
在 2352542 例患者中，有 199 例符合最终分析标准。主动脉球囊阻断复苏术+创伤性脑损伤患者的格拉斯哥昏迷量表评分≤8（82.4%比 54.4%，P<0.001）和收缩压（89±37.4 比 107.2±39.7；P=0.002）明显更低，损伤严重程度评分>25（83.5%比 65.8%，P=0.01）的患者明显更多。两组患者住院死亡率（62.4%比 50.9%，P=0.11）或并发症（17.7%比 11.4%，P=0.21）无差异。基于损伤机制、创伤中心级别、教学医院状态和骨盆骨折状态的亚组分析也未显示死亡率存在差异。
尽管创伤性脑损伤患者的损伤严重程度更高，入院时血压更低，但接受主动脉球囊阻断复苏术治疗的患者，其住院死亡率与合并或不合并创伤性脑损伤的患者无差异。
