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创伤中的主动脉内球囊阻断术:一种挽救生命的干预措施还是一次重大失败?

REBOA in trauma: a life-saving intervention or a spectacular failure?

作者信息

Joseph Bellal, Demetriades Demetrios

机构信息

Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery and Burns, College of Medicine, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA.

Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA.

出版信息

Eur J Trauma Emerg Surg. 2024 Dec;50(6):2689-2695. doi: 10.1007/s00068-024-02657-x. Epub 2024 Sep 9.

Abstract

PURPOSE

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a controversial haemorrhage control intervention often touted as the bridge to definitive haemorrhage control. This review summarizes the evolution of REBOA from its inception to the latest applications with an emphasis on clinical outcomes.

METHODS

This is a narrative review based on a selective review of the literature.

RESULTS

REBOA remains a rarely utilized intervention in trauma patients. Complications have remained consistent over time despite purported improvements in catheter technology. Ischemia-reperfusion injuries, end-organ dysfunction, limb ischemia, and amputations have all been reported. Evidence-based guidelines are lacking, and appropriate indications and the ideal patient population for this intervention are yet to be defined.

CONCLUSION

Despite the hype, purported technological advancements, and the mirage of high-quality studies over the last decade, REBOA has failed to keep up to its expectations. The quest to find the solution for uncontrolled NCTH remains unsolved.

摘要

目的

复苏性血管内主动脉球囊阻断术(REBOA)是一种存在争议的出血控制干预措施,常被吹捧为实现确定性出血控制的桥梁。本综述总结了REBOA从起源到最新应用的发展历程,重点关注临床结局。

方法

这是一篇基于文献选择性回顾的叙述性综述。

结果

REBOA在创伤患者中仍然是一种很少使用的干预措施。尽管导管技术据称有所改进,但并发症一直保持稳定。缺血再灌注损伤、终末器官功能障碍、肢体缺血和截肢均有报道。缺乏循证指南,该干预措施的合适适应证和理想患者群体尚未明确。

结论

尽管在过去十年中受到炒作、所谓的技术进步以及高质量研究的幻象,但REBOA未能达到预期。寻找控制非可控性创伤性大出血解决方案的探索仍未解决。

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