Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Isral, Affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-aviv, Israel.
Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Surgeon. 2024 Feb;22(1):37-42. doi: 10.1016/j.surge.2023.08.001. Epub 2023 Aug 30.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method for temporary hemorrhage control used in haemodynamically unwell patients with severe bleeding. In haemodynamically unwell abdominal trauma patients, laparotomy remains the initial procedure of choice. Using REBOA in patients as a bridge to laparotomy is a novel option whose feasibility and efficacy remain unclear. We aimed to assess the clinical outcome in patients with abdominal injury who underwent both REBOA placement and laparotomy.
This is a retrospective study, including trauma patients with an isolated abdominal injury who underwent both REBOA placement and laparotomy, during the period 2011-2019. All data were collected via the Aortic Balloon Occlusion Trauma Registry database.
One hundred and three patients were included in this study. The main mechanism of trauma was blunt injury (62.1%) and the median injury severity score (ISS) was 33 (14-74). Renal failure and multi-organ dysfunction syndrome (MODS) occurred in 15.5% and 35% of patients, respectively. Overall, 30-day mortality was 50.5%. Post balloon inflation systolic blood pressure (SBP) >80 mmHg was associated with lower 24-h mortality (p = 0.007). No differences in mortality were found among patients who underwent partial occlusion vs. total occlusion of the aorta.
Our results support the feasibility of REBOA use in patients with isolated abdominal injury, with survival rates similar to previous reports for haemodynamically unstable abdominal trauma patients. Post-balloon inflation SBP >80 mmHg was associated with a significant reduction in 24-h mortality rates, but not 30-day mortality. Total aortic occlusion was not associated with increased mortality, MODS, and complication rates compared with partial occlusion.
主动脉球囊阻断复苏术（REBOA）是一种用于治疗血流动力学不稳定伴严重出血患者的临时止血方法。对于血流动力学不稳定的腹部创伤患者，剖腹手术仍然是首选的初始治疗方法。在这些患者中，将 REBOA 用作剖腹手术的桥梁是一种新的选择，但其实用性和疗效尚不清楚。我们旨在评估接受 REBOA 置管和剖腹手术的腹部创伤患者的临床结局。
这是一项回顾性研究，纳入了 2011 年至 2019 年期间接受 REBOA 置管和剖腹手术的孤立性腹部创伤患者。所有数据均通过主动脉球囊阻断创伤登记数据库收集。
本研究共纳入 103 例患者。主要创伤机制为钝性损伤（62.1%），损伤严重程度评分（ISS）中位数为 33（14-74）。肾衰竭和多器官功能障碍综合征（MODS）分别发生在 15.5%和 35%的患者中。总体而言，30 天死亡率为 50.5%。球囊充气后收缩压（SBP）＞80mmHg 与 24 小时死亡率降低相关（p=0.007）。主动脉部分阻断与完全阻断患者的死亡率无差异。
我们的结果支持在孤立性腹部创伤患者中使用 REBOA 的可行性，生存率与先前报道的血流动力学不稳定的腹部创伤患者相似。球囊充气后 SBP＞80mmHg 与 24 小时死亡率显著降低相关，但与 30 天死亡率无关。与部分阻断相比，完全阻断主动脉并未增加死亡率、MODS 和并发症发生率。
