Maiga Amelia Walling, Kundi Rishi, Morrison Jonathan James, Spalding Chance, Duchesne Juan, Hunt John, Nguyen Jonathan, Benjamin Elizabeth, Moore Ernest E, Lawless Ryan, Beckett Andrew, Russo Rachel, Dennis Bradley M
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
Trauma Surg Acute Care Open. 2022 Dec 23;7(1):e000984. doi: 10.1136/tsaco-2022-000984. eCollection 2022.
Patient selection for resuscitative endovascular balloon occlusion of the aorta (REBOA) has evolved during the last decade. A recent multicenter collaboration to implement the newest generation REBOA balloon catheter identified variability in patient selection criteria. The aims of this systematic review were to compare recent REBOA patient selection guidelines and to identify current areas of consensus and variability.
In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of clinical practice guidelines for REBOA patient selection in trauma. Published algorithms from 2015 to 2022 and institutional guidelines from a seven-center REBOA collaboration were compiled and synthesized.
Ten published algorithms and seven institutional guidelines on REBOA patient selection were included. Broad consensus exists on REBOA deployment for blunt and penetrating trauma patients with non-compressible torso hemorrhage refractory to blood product resuscitation. Algorithms diverge on precise systolic blood pressure triggers for early common femoral artery access and REBOA deployment, as well as the use of REBOA for traumatic arrest and chest or extremity hemorrhage control.
Although our convenience sample of institutional guidelines likely underestimates patient selection variability, broad consensus exists in the published literature regarding REBOA deployment for blunt and penetrating trauma patients with hypotension not responsive to resuscitation. Several areas of patient selection variability reflect individual practice environments.
Level 5, systematic review.
在过去十年中，用于复苏性血管内主动脉球囊阻断术（REBOA）的患者选择标准不断演变。最近一项实施新一代REBOA球囊导管的多中心合作发现患者选择标准存在差异。本系统评价的目的是比较近期REBOA患者选择指南，并确定当前的共识和差异领域。
根据系统评价和Meta分析的首选报告项目指南，我们对创伤中REBOA患者选择的临床实践指南进行了系统评价。汇总并综合了2015年至2022年发布的算法以及来自一个七中心REBOA合作项目的机构指南。
纳入了十篇关于REBOA患者选择的已发表算法和七篇机构指南。对于钝性和穿透性创伤患者，若出现经血液制品复苏后仍无法控制的躯干出血，在进行REBOA治疗方面存在广泛共识。在早期股总动脉穿刺和REBOA治疗的精确收缩压触发点，以及REBOA在创伤性心脏骤停和胸部或肢体出血控制中的应用方面，算法存在分歧。
尽管我们方便获取的机构指南样本可能低估了患者选择的差异，但已发表的文献中对于REBOA用于低血压且复苏无效的钝性和穿透性创伤患者的治疗存在广泛共识。患者选择差异的几个领域反映了个体的实践环境。
5级，系统评价。
