Liao Chien-An, Huang Shu-Yi, Hsu Chih-Po, Lin Ya-Chiao, Cheng Chi-Tung, Huang Jen-Fu, Li Hsi-Hsin, Tung Wen-Ya, Chen Yi-Jung, Chen Ken-Hsiung, Wang Shih-Tien
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
Department of General Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Injury. 2025 Jan;56(1):111916. doi: 10.1016/j.injury.2024.111916. Epub 2024 Sep 23.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) serves as a bridging intervention for subsequent definitive haemorrhagic control. This study compared the clinical outcomes of REBOA and resuscitative thoracotomy (RT) in patients with bleeding below the diaphragm.
This retrospective cohort study included adult trauma patients who presented to the Trauma Quality Improvement Program between 2020 and 2021 and who underwent either REBOA or RT in the emergency department (ED). Patients with severe head and chest injuries, characterised by an Abbreviated Injury Scale (AIS) score greater than 3, were excluded. The clinical data of patients treated with REBOA and those treated with RT were compared, and multivariable logistic regression (MLR) was employed to identify prognostic factors associated with mortality.
A total of 346 patients were enrolled: 138 (39.9 %) received REBOA, and 208 (60.1 %) received RT at the ED. Patients in the RT group underwent ED cardiopulmonary resuscitation (CPR) more frequently (58.2 % vs. 23.2 %; p < 0.001) and had a higher mortality rate (87.0 % vs. 45.7 %; p < 0.001). Patients who died had lower Glasgow Coma Scale scores (6 [4.5] vs. 11 [4.9]; p < 0.001), underwent more ED CPR (58.6 % vs. 9.8 %; p < 0.001), and received RT more frequently (74.2 % vs. 26.5 %, p < 0.001). The MLR revealed that the major prognostic factors for mortality were systolic blood pressure (odds ratio [OR] 0.988, 95 % confidence interval [CI] 0.978-0.998; p = 0.014), ED CPR (OR 11.111, 95 % CI 4.667-26.452; p < 0.001), abdominal injuries with an AIS score ≥ 4 (OR 4.694, 95 % CI 1.921-11.467; p = 0.001) and RT (OR 5.693, 95 % CI 2.690-12.050; p < 0.001).
In cases of blunt trauma, prompt identification of the bleeding source is crucial. For patients with bleeding below the diaphragm, REBOA led to higher survival rates than did RT. However, it is important to consider the limitations of the database and the necessary exclusions from our analysis.
主动脉内复苏性球囊阻断术（REBOA）是后续确定性出血控制的一种桥接干预措施。本研究比较了膈下出血患者接受REBOA和复苏性开胸手术（RT）的临床结局。
这项回顾性队列研究纳入了2020年至2021年间就诊于创伤质量改进项目且在急诊科接受REBOA或RT的成年创伤患者。排除了以简明损伤量表（AIS）评分大于3为特征的严重头部和胸部损伤患者。比较了接受REBOA治疗和接受RT治疗患者的临床数据，并采用多变量逻辑回归（MLR）来确定与死亡率相关的预后因素。
共纳入346例患者：138例（39.9%）在急诊科接受了REBOA，208例（60.1%）接受了RT。RT组患者在急诊科接受心肺复苏（CPR）的频率更高（58.2%对23.2%；p<0.001），死亡率也更高（87.0%对45.7%；p<0.001）。死亡患者的格拉斯哥昏迷量表评分较低（6[4.5]对11[4.9]；p<0.001），在急诊科接受CPR的次数更多（58.6%对9.8%；p<0.001），接受RT的频率也更高（74.2%对26.5%，p<0.001）。MLR显示，死亡率的主要预后因素为收缩压（比值比[OR]0.988，95%置信区间[CI]0.978 - 0.998；p = 0.014）、急诊科CPR（OR 11.111，95%CI 4.667 - 26.452；p<0.001）、AIS评分≥4的腹部损伤（OR 4.694，95%CI 1.921 - 11.467；p = 0.001）和RT（OR 5.693，95%CI 2.690 - 12.050；p<0.001）。
在钝性创伤病例中，迅速识别出血源至关重要。对于膈下出血患者，REBOA的生存率高于RT。然而，重要的是要考虑数据库的局限性以及我们分析中必要的排除情况。
