Kuo Ling-Wei, Liao Chien-Hung, Cheng Chi-Tung, Fu Chih-Yuan, Liao Chien-An, Wang Chia-Cheng, Huang Jen-Fu, Hsu Chi-Po
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
Chang Gung University, Taoyuan, Taiwan.
Trauma Surg Acute Care Open. 2024 Aug 13;9(1):e001460. doi: 10.1136/tsaco-2024-001460. eCollection 2024.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been an established life-saving procedure for adult trauma patients, but the evidence for its use in pediatric patients is still under question. The purpose of this study was to examine the outcome of REBOA in pediatric patients.
We retrospectively analyzed observational cohort data from the American College of Surgeons-Trauma Quality Improvement Program from 2017 to 2019. We analyzed 183 506 trauma patients aged 7-18, and 111 patients were matched by propensity score analysis. Basic demographics, injury severity, trauma type, and clinical outcomes of the patients receiving REBOA and those not receiving REBOA were compared. In the REBOA patients, a subgroup analysis was performed to evaluate the potential influence of age and body weight on the outcomes of REBOA.
After the pretreatment factors were balanced for the REBOA and no-REBOA groups, the patients in the REBOA group had more transfused packed red blood cells within the first 4 hours (3250 mL vs. 600 mL, p<0.001), and the mortality rate was higher in the REBOA group, but it did not reach statistical significance (56.8% vs. 36.5%, p=0.067). No significant difference was detected regarding in-hospital complications. In the subgroup analysis of the patients who received REBOA, we discovered no significant difference in mortality and complications between the subgroups when compared by age (>15 years old/≤15 years old) or weight (>58 kg or ≤58 kg).
Pediatric trauma patients who received REBOA were not significantly associated with an increased risk of mortality when compared with no-REBOA patients with matched basic demographics and pretreatment factors. Younger age and lighter body weight did not seem to influence the outcomes of REBOA regarding survival and complications.
Level III.
主动脉内复苏球囊阻断术（REBOA）已成为成年创伤患者公认的挽救生命的手术，但该手术在儿科患者中的应用证据仍存在疑问。本研究的目的是探讨REBOA在儿科患者中的治疗效果。
我们回顾性分析了美国外科医师学会创伤质量改进项目2017年至2019年的观察性队列数据。我们分析了183506名7至18岁的创伤患者，并通过倾向评分分析匹配了111名患者。比较了接受REBOA和未接受REBOA患者的基本人口统计学特征、损伤严重程度、创伤类型和临床结局。在接受REBOA的患者中，进行了亚组分析，以评估年龄和体重对REBOA结局的潜在影响。
在对REBOA组和非REBOA组的预处理因素进行平衡后，REBOA组患者在最初4小时内输注的红细胞更多（3250 mL对600 mL，p<0.001），且REBOA组的死亡率更高，但未达到统计学意义（56.8%对36.5%，p=0.067）。在院内并发症方面未检测到显著差异。在接受REBOA患者的亚组分析中，按年龄（>15岁/≤15岁）或体重（>58 kg或≤58 kg）比较时，各亚组之间在死亡率和并发症方面未发现显著差异。
与具有匹配基本人口统计学特征和预处理因素的未接受REBOA的患者相比，接受REBOA的儿科创伤患者死亡风险没有显著增加。年龄较小和体重较轻似乎不影响REBOA在生存和并发症方面的结局。
三级。
