Haruta Koichi, Endo Akira, Shiraishi Atsushi, Otomo Yasuhiro
Graduate School of Medicine Tokyo Medical and Dental University Hospital Tokyo Japan.
Department of Emergency Medicine, Shizuoka Prefectural Hospital Organization Shizuoka General Hospital Shizuoka Japan.
Acute Med Surg. 2023 Mar 14;10(1):e830. doi: 10.1002/ams2.830. eCollection 2023 Jan-Dec.
To compare in-hospital mortality of severely injured trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) or aortic cross-clamping (ACC).
In this multicenter, retrospective cohort study using data from a nationwide trauma registry of tertiary emergency medical centers in Japan ( = 280), trauma patients who underwent aortic occlusion at the emergency department from 2004 to 2019 were divided into two groups according to the treatment they received: patients treated with ACC and patients who underwent placement of a REBOA catheter. Multiple imputations were used to handle the missing data. In-hospital mortality of the patients who underwent REBOA or ACC was compared using a mixed-effect logistic regression analysis and a propensity score-matching analysis, in which the confounders, including baseline patient demographics and severity, were adjusted.
Of 1,670 patients (1,137 with REBOA and 533 with ACC), 66% were male. The median age was 56 years, and the mortality rate was 55.2% in the REBOA group and 81.6% in the ACC group. The mixed-effect model regression analysis showed a significantly lower odds ratio for in-hospital mortality rate in the REBOA group (odds ratio 0.17; 95% confidence interval, 0.12-0.26). A similar odds ratio was observed in the propensity score matching analysis (odds ratio 0.27; 95% confidence interval, 0.18-0.40).
Compared with ACC, REBOA use was associated with decreased mortality in severely injured trauma patients.
比较接受主动脉复苏性血管内球囊阻断术（REBOA）或主动脉交叉钳夹术（ACC）的严重创伤患者的院内死亡率。
在这项多中心回顾性队列研究中，使用来自日本三级急诊医疗中心全国创伤登记处的数据（n = 280），将2004年至2019年在急诊科接受主动脉阻断术的创伤患者根据其接受的治疗分为两组：接受ACC治疗的患者和接受REBOA导管置入术的患者。采用多重填补法处理缺失数据。使用混合效应逻辑回归分析和倾向得分匹配分析比较接受REBOA或ACC治疗患者的院内死亡率，其中对包括患者基线人口统计学和严重程度在内的混杂因素进行了调整。
在1670例患者中（1137例接受REBOA治疗，533例接受ACC治疗），66%为男性。中位年龄为56岁，REBOA组的死亡率为55.2%，ACC组为81.6%。混合效应模型回归分析显示，REBOA组的院内死亡率比值比显著更低（比值比0.17；95%置信区间，0.12 - 0.26）。倾向得分匹配分析中观察到类似的比值比（比值比0.27；95%置信区间，0.18 - 0.40）。
与ACC相比，使用REBOA与严重创伤患者死亡率降低相关。
