高复苏性血管内球囊阻断主动脉术式量与改善结局相关：AORTA 注册研究分析。
High resuscitative endovascular balloon occlusion of the aorta procedural volume is associated with improved outcomes: An analysis of the AORTA registry.
机构信息
From the Department of Surgery, Rutgers New Jersey Medical School (E.G., D.H.L.), Newark, New Jersey; NYU Langone Department of Surgery, Division of Acute Care Surgery, Bellevue Hospital Center (B.N., M.K., C.DM., M.B.), New York, New York; Los Angeles County + University of Southern California Hospital (K.I.), Los Angeles, California; Los Angeles County + University of Southern California Medical Center, Division of Trauma/Surgical Critical Care, Los Angeles, California; R. Adams Cowley Shock Trauma Center/CSTARS (Center for the Sustainment of Trauma and Readiness Skills) (J.M., T.S., C.F., J.D.), University of Maryland, Baltimore, Maryland; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania (M.Se.), Philadelphia, Pennsylvania; Memorial Hermann Texas Medical Center (L.M.), Department of Surgery, University of Texas Houston Medical School, San Antonio Military Medical Center/US Army Institute of Surgical Research (D.K.), San Antonio, Texas; and Ohio Health, Grant Medical Center (M.Sp.), Columbus, Ohio.
出版信息
J Trauma Acute Care Surg. 2021 Nov 1;91(5):781-789. doi: 10.1097/TA.0000000000003201.
BACKGROUND
The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) is controversial. We hypothesize that REBOA outcomes are improved in centers with high REBOA utilization.
METHODS
We examined the Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry over a 5-year period (2014-2018). Resuscitative endovascular balloon occlusion of the aorta outcomes were analyzed by stratifying institutions into low-volume (<10), average-volume (11-30), and high-volume (>30) deployment centers. A multivariable model adjusting for volume group, mechanism of injury, signs of life, systolic blood pressure at initiation, operator level, device type, zone of placement, and hemodynamic response to aortic occlusion was created to analyze REBOA mortality and REBOA-related complications.
RESULTS
Four hundred ninety-five REBOA placements were included. High-volume centers accounted for 63%, while low accounted for 13%. High-volume institutions were more likely to place a REBOA in the emergency department (81% vs. 63% low volume, p = 0.003), had a lower mean systolic blood pressure at insertion (53 ± 38 vs. 64 ± 40, p = 0.001), and more Zone I deployments (64% vs. 55%, p = 0.002). Median time from admission to REBOA placement was significantly less in patients treated at high-volume centers (15 [7-30] minutes vs. 35 [20-65] minutes, p = 0.001). Resuscitative endovascular balloon occlusion of the aorta mortality was significantly higher at low-volume centers (67% vs. 57%; adjusted odds ratio, 1.29; adj p = 0.040), while average- and high-volume centers were similar. Resuscitative endovascular balloon occlusion of the aorta complications were less frequent at high-/average-volume centers, but did not reach statistical significance (adj p = 0.784).
CONCLUSION
Resuscitative endovascular balloon occlusion of the aorta survival is increased at high versus low utilization centers. Increased experience with REBOA may be associated with earlier deployment and subsequently improved patient outcomes.
LEVEL OF EVIDENCE
Therapeutic/Care Management, level IV.
背景
使用主动脉腔内球囊阻断复苏术（REBOA）存在争议。我们假设在 REBOA 使用率高的中心，REBOA 的结果会得到改善。
方法
我们在 5 年期间（2014-2018 年）检查了创伤和急性护理手术的主动脉阻断复苏登记处。通过将机构分为低容量（<10）、平均容量（11-30）和高容量（>30）部署中心，对 REBOA 结果进行分层分析。创建了一个多变量模型，该模型调整了体积组、损伤机制、生命迹象、开始时的收缩压、操作人员级别、设备类型、放置区域以及主动脉阻断后的血液动力学反应，以分析 REBOA 死亡率和与 REBOA 相关的并发症。
结果
共纳入 495 例 REBOA 放置。高容量中心占 63%，而低容量中心占 13%。高容量机构更有可能在急诊科放置 REBOA（81%比低容量中心的 63%，p=0.003），插入时的平均收缩压更低（53±38比 64±40，p=0.001），且更多的 I 区部署（64%比 55%，p=0.002）。在高容量中心治疗的患者，从入院到 REBOA 放置的中位时间明显更短（15[7-30]分钟比 35[20-65]分钟，p=0.001）。低容量中心的 REBOA 死亡率明显更高（67%比 57%；调整后的优势比，1.29；adj p=0.040），而平均和高容量中心相似。高/平均容量中心的 REBOA 并发症发生率较低，但没有达到统计学意义（adj p=0.784）。
结论
与低使用率中心相比，高使用率中心的 REBOA 存活率增加。REBOA 经验的增加可能与更早的部署有关，并随后改善患者的预后。
证据水平
治疗/护理管理，IV 级。
Zotero 插件