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治疗严重出血性创伤的先进方法:选择性主动脉弓灌注与紧急保存和复苏——接下来会怎样?

State-of-the-art methods for the treatment of severe hemorrhagic trauma: selective aortic arch perfusion and emergency preservation and resuscitation-what is next?

作者信息

Iida Atsuyoshi, Naito Hiromichi, Nojima Tsuyoshi, Yumoto Tetsuya, Yamada Taihei, Fujisaki Noritomo, Nakao Atsunori, Mikane Takeshi

机构信息

Department of Emergency Medicine Japanese Red Cross Okayama Hospital 2-1-1 Aoe, Kita ward Okayama Okayama 7008607 Japan.

Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences 2-5-1 Sikatatyo Okayama Okayama 7008558 Japan.

出版信息

Acute Med Surg. 2021 Mar 26;8(1):e641. doi: 10.1002/ams2.641. eCollection 2021 Jan-Dec.

Abstract

Trauma is a primary cause of death globally, with non-compressible torso hemorrhage constituting an important part of "potentially survivable trauma death." Resuscitative endovascular balloon occlusion of the aorta has become a popular alternative to aortic cross-clamping under emergent thoracotomy for non-compressible torso hemorrhage in recent years, however, it alone does not improve the survival rate of patients with severe shock or traumatic cardiac arrest from non-compressible torso hemorrhage. Development of novel advanced maneuvers is essential to improve these patients' survival, and research on promising methods such as selective aortic arch perfusion and emergency preservation and resuscitation is ongoing. This review aimed to provide physicians in charge of severe trauma cases with a broad understanding of these novel therapeutic approaches to manage patients with severe hemorrhagic trauma, which may allow them to develop lifesaving strategies for exsanguinating trauma patients. Although there are still hurdles to overcome before their clinical application, promising research on these novel strategies is in progress, and ongoing development of synthetic red blood cells and techniques that reduce ischemia-reperfusion injury may further maximize their effects. Both continuous proof-of-concept studies and translational clinical evaluations are necessary to clinically apply these hemostasis approaches to trauma patients.

摘要

创伤是全球主要的死亡原因,不可压缩性躯干出血是“潜在可存活创伤死亡”的重要组成部分。近年来,对于不可压缩性躯干出血,复苏性血管内主动脉球囊阻断术已成为紧急开胸主动脉交叉钳夹术的一种常用替代方法,然而,它本身并不能提高因不可压缩性躯干出血导致的严重休克或创伤性心脏骤停患者的生存率。开发新的先进操作对于提高这些患者的生存率至关重要,目前正在对选择性主动脉弓灌注和紧急保存与复苏等有前景的方法进行研究。这篇综述旨在让负责严重创伤病例的医生广泛了解这些用于治疗严重出血性创伤患者的新型治疗方法,这可能使他们为失血创伤患者制定挽救生命的策略。尽管在临床应用之前仍有障碍需要克服,但对这些新策略的研究很有前景,并且合成红细胞和减少缺血再灌注损伤技术的不断发展可能会进一步最大化它们的效果。持续的概念验证研究和转化临床评估对于将这些止血方法临床应用于创伤患者都是必要的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14fb/7995927/d94828782330/AMS2-8-e641-g002.jpg

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