Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki, 300-0028, Japan.
Department of Acute Critical Care and Disaster Medicine, Graduate School of Medicine and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan.
World J Emerg Surg. 2024 May 31;19(1):19. doi: 10.1186/s13017-024-00548-5.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed.
This retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score.
Overall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival.
While there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care.
主动脉腔内球囊阻断复苏术（REBOA）已被用于控制大出血。尽管 REBOA 的疗效尚无共识，但在没有创伤外科医生的非创伤中心，它仍然是一种桥接治疗的选择。为了更好地了解 REBOA 在日本的应用现状，我们研究了其使用、目标人群和治疗结果的变化，因为在日本，有时无法立即进行止血手术。
本回顾性观察性研究使用了日本创伤数据库的数据。纳入了 2004 年 1 月至 2021 年 12 月期间接受 REBOA 治疗的所有病例。主要结局是院内死亡率。我们根据病例数、中心数、损伤严重程度以及与 REBOA 使用相关的总体和亚组死亡率，分析了随时间推移的死亡率趋势。我们对随时间推移的死亡率趋势进行了逻辑分析，并根据创伤和损伤严重程度评分调整了生存概率。
总体而言，共有 2557 例患者接受了 REBOA 治疗，并被认为符合纳入标准。参与者的中位年龄为 55 岁，男性占研究人群的 65.3%。钝性创伤约占病例的 93.0%。使用 REBOA 的病例数和机构数量在 2019 年之前增加。虽然在整个观察期间损伤严重程度评分和修订创伤评分没有变化，但医院死亡率从 91.3%降至 50.9%。无严重头部或脊柱损伤的 REBOA 组与使用 REBOA 的所有患者组和所有创伤患者组相比，死亡率改善更为显著。在收缩压≥80mmHg 的患者中，死亡率的改善最大。即使在调整了生存概率后，医院死亡率的调整比值比也稳步下降。
尽管患者严重程度没有明显变化，但接受 REBOA 治疗的患者死亡率随时间推移而下降。需要进一步研究以确定创伤护理改善的原因。
