Charbit Jonathan, Dagod Geoffrey, Darcourt Simon, Margueritte Emmanuel, Souche François-Regis, Solovei Laurence, Monnin-Barres Valérie, Millet Ingrid, Capdevila Xavier
Trauma and Polyvalent Critical Care Unit, Lapeyronie University Hospital, Montpellier, France.
Trauma and Polyvalent Critical Care Unit, Lapeyronie University Hospital, Montpellier, France.
Injury. 2025 Jan;56(1):111952. doi: 10.1016/j.injury.2024.111952. Epub 2024 Oct 13.
The present study investigated an institutional multidisciplinary strategy for managing traumatic haemorrhagic shock by integrating the placement of REBOA (resuscitative endovascular balloon occlusion of the aorta) by anaesthesiologist-intensivists.
All severe trauma patients who received percutaneous REBOA placement between January 2013 and December 2022 in our level 1 trauma centre were retrospectively analysed. The data collected included the clinical context, indications and location of REBOA, durations of aortic occlusion (AO), choice of haemostatic procedures and surgical teams, and specific complications.
In total, 38 trauma patients were included in the present study (mean age = 41 years [standard deviation = 21 years], 31 [82 %] were male, and median injury severity score was 62.5 [inter-quartile range (IQR) = 45-75]). REBOA was always placed by anaesthesiologist-intensivists, who comprised 68 % of the senior physicians (13/19) in our trauma team over the period. Twenty-eight AOs (74 %) were performed in zone 1 and 10 (26 %) in zone 3. Twelve patients (32 %) received REBOA upon circulatory arrest. Routes following REBOA placement comprised: computed tomography scan = 47 %, operating room = 34 %, angiography = 3 %, emergency room thoracotomy = 5 %, and prematurely died = 11 %. Duration of AO was 38 min (IQR = 32-44 min) in zone 1 and 78 min (IQR = 48-112 min) in zone 3. Mortality rate was 66 % (95 % CI 51-81 %) and higher in cases of AO in zone 1 (79 % versus 30 %, p = 0.018) or concomitant with circulatory arrest (92 % versus 54 %, p = 0.047). No ischemic limb needed an intervention and three endothelial injuries required delayed endovascular stenting.
Percutaneous REBOA placement by anaesthesiologist-intensivists included in the multidisciplinary management of traumatic haemorrhagic shock was associated with acceptable time of AO and local complications similar to those observed in other series.
本研究探讨了一种机构多学科策略，通过麻醉科重症医学专家进行主动脉内球囊阻断术（REBOA）来管理创伤性失血性休克。
回顾性分析了2013年1月至2022年12月期间在我们的一级创伤中心接受经皮REBOA置入术的所有严重创伤患者。收集的数据包括临床背景、REBOA的适应证和位置、主动脉阻断（AO）持续时间、止血程序和手术团队的选择以及特定并发症。
本研究共纳入38例创伤患者（平均年龄=41岁[标准差=21岁]，31例[82%]为男性，损伤严重程度评分中位数为62.5[四分位间距（IQR）=45-75]）。REBOA均由麻醉科重症医学专家置入，在此期间，他们占我们创伤团队高级医师的68%（13/19）。28次AO（74%）在1区进行，10次（26%）在3区进行。12例患者（32%）在循环骤停时接受REBOA。REBOA置入后的路径包括：计算机断层扫描=47%，手术室=34%，血管造影=3%，急诊室开胸手术=5%，过早死亡=11%。1区AO持续时间为38分钟（IQR=32-44分钟），3区为78分钟（IQR=48-112分钟）。死亡率为66%（95%CI 51-81%），1区AO患者的死亡率更高（79%对30%，p=0.018）或伴有循环骤停的患者（92%对54%，p=0.047）。没有缺血肢体需要干预，3例内皮损伤需要延迟血管内支架置入术。
麻醉科重症医学专家在创伤性失血性休克的多学科管理中进行经皮REBOA置入术，其AO时间可接受，局部并发症与其他系列观察到的相似。
