Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria.
Department of Anaesthesiology and Intensive Care Medicine, Medical University Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
Sci Rep. 2024 Apr 20;14(1):9111. doi: 10.1038/s41598-024-59778-x.
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful in treating exsanguinating trauma patients. This study seeks to compare rates of success, complications and time required for vascular access between ultrasound-guidance and surgical cut-down for femoral sheath insertion as a prospective observational case control study. Participating clinicians from either trauma surgery or anesthesiology were allocated to surgical cut-down or percutaneous ultrasound-guided puncture on a 1:1 ratio. Time spans to vessel identification, successful puncture, and balloon inflation were recorded. 80 study participants were recruited and allocated to 40 open cut-down approaches and 40 percutaneous ultrasound-guided approaches. REBOA catheter placement was successful in 18/40 cases (45%) using a percutaneous ultrasound guided technique and 33/40 times (83%) using the open cut-down approach (p < 0.001). Median times [in seconds] compared between percutaneous ultrasound-guided puncture and surgical cut-down were 36 (18-73) versus 117(56-213) for vessel visualization (p < 0.001), 136 (97-175) versus 183 (156-219) for vessel puncture (p < 0.001), and 375 (240-600) versus 288 (244-379) for balloon inflation (p = 0.08) overall. Access to femoral vessels for REBOA catheter placement is safer when performed by cut-down and direct visualization but can be performed faster by an ultrasound-guided technique when vessels can be identified clearly and rapidly.
主动脉腔内球囊阻断复苏（REBOA）可能对治疗出血性创伤患者有用。本研究旨在比较超声引导与手术切开两种方法用于股鞘插入时的成功率、并发症和血管通路建立所需时间，这是一项前瞻性观察性病例对照研究。创伤外科或麻醉科的参与临床医生按照 1:1 的比例被分配到手术切开或经皮超声引导穿刺。记录血管识别、成功穿刺和球囊充气所需的时间跨度。共招募了 80 名研究参与者，并将其分配到 40 例开放切开入路和 40 例经皮超声引导入路。使用经皮超声引导技术，REBOA 导管放置成功率为 18/40 例（45%），而使用开放切开入路的成功率为 33/40 例（83%）（p<0.001）。经皮超声引导穿刺与手术切开相比，穿刺部位血管可视化的中位数时间[秒]分别为 36（18-73）与 117（56-213）（p<0.001），血管穿刺的中位数时间分别为 136（97-175）与 183（156-219）（p<0.001），球囊充气的中位数时间分别为 375（240-600）与 288（244-379）（p=0.08）。切开直视下进行 REBOA 导管置管术时，股血管通路的安全性更高，但如果可以快速明确并识别血管，经皮超声引导技术可以更快地完成操作。
