Hsu Shuo-Ting, Fu Yi-Kai, Lin Hao-Yang, Chiang Wen-Chu, Chiu Yu-Chen, Sun Jen-Tang, Ma Matthew Huei-Ming
Far Eastern Memorial Hospital Department of Emergency Medicine New Taipei City Taiwan.
National Taiwan University Hospital Yun-Lin Branch Department of Emergency Medicine Yunlin Taiwan.
J Acute Med. 2022 Sep 1;12(3):126-130. doi: 10.6705/j.jacme.202209_12(3).0006.
Exsanguinating torso hemorrhage is a leading cause of death in trauma patients. Bleeding leads to hypothermia, acidosis, and coagulopathy, the so-called "lethal triad," and creates a vicious cycle. Therefore, bleeding control tops the priority list in the management of trauma patients. Placement of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with traumatic non-compressible torso hemorrhage is a developing technique in the emergency departments (EDs) in Taiwan, and it is a possible solution for abdominal and pelvic trauma patients with hemodynamic instability. It not only temporarily controls bleeding below the inflation site but also increases cerebral and coronary circulation. It can create a bridge for definitive care such as an operation or an embolization, possibly preventing death. Compared to thoracotomy followed by an aortic cross clamp, REBOA is a less invasive and possibly, a more efficient way to control the hemorrhage and may lead to better overall survival. The use of REBOA has been proven to be associated with improved survival-to-discharge in severely injured trauma patients. We report a case of out-of-hospital cardiac arrest caused by penetrating injury wherein return of spontaneous circulation was successfully achieved after 39-minute cardiopulmonary resuscitation and REBOA placement in the ED. The REBOA balloon was deflated after bleeding was stopped during the laparotomy operation. The patient was then transferred to the intensive care unit for postoperative care. Unfortunately, the patient passed away approximately 12 hours after the surgery.
躯干大出血是创伤患者死亡的主要原因。出血会导致体温过低、酸中毒和凝血功能障碍，即所谓的“致命三联征”，并形成恶性循环。因此，控制出血是创伤患者管理中的首要任务。在台湾的急诊科，对创伤性不可压迫性躯干出血患者进行复苏性血管内主动脉球囊阻断术（REBOA）是一种正在发展的技术，对于血流动力学不稳定的腹部和盆腔创伤患者来说是一种可能的解决方案。它不仅能暂时控制球囊充气部位以下的出血，还能增加脑循环和冠状动脉循环。它可以为手术或栓塞等确定性治疗搭建桥梁，有可能预防死亡。与开胸后夹闭主动脉相比，REBOA是一种侵入性较小且可能更有效的控制出血的方法，可能会带来更好的总体生存率。已证明使用REBOA与严重受伤的创伤患者出院生存率的提高有关。我们报告一例因穿透伤导致的院外心脏骤停病例，在急诊科进行39分钟心肺复苏并放置REBOA后成功实现自主循环恢复。在剖腹手术中出血停止后，REBOA球囊放气。然后患者被转至重症监护病房进行术后护理。不幸的是，患者在手术后约12小时去世。
