Marsden Max, Lendrum Robert, Perkins Zane, Davenport Ross A
Major Trauma Service, Bart's Health NHS Trust, London, UK.
Academic Department of Military Surgery and Trauma, Research and Clinical Innovation, Birmingham, UK.
Curr Opin Anaesthesiol. 2025 Apr 1;38(2):100-106. doi: 10.1097/ACO.0000000000001474. Epub 2025 Feb 13.
The management of noncompressible haemorrhage (NCH) remains a critical challenge in trauma care, with early mortality rates persistently high despite advances in trauma systems. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a potential intervention to address severe haemorrhage in prehospital and hospital settings. This review examines the role of REBOA in remote damage control resuscitation, focusing on the 'golden hour' and the 'platinum 5 minutes' concepts that underscore the urgency of timely interventions.
Evidence from the UK-REBOA trial and related studies highlights the complexity of implementing REBOA in prehospital settings, emphasising the importance of early deployment, appropriate patient selection, and minimisation of delays. Technological innovations, including AI-assisted decision-making and automated partial REBOA systems, offer promising avenues for optimising REBOA's application. Furthermore, the concept of damage control prehospital care prioritises essential interventions tailored to individual patient needs, advocating for a streamlined approach to reduce on-scene time.
The integration of REBOA with advanced prehospital strategies holds the potential for reducing preventable deaths from traumatic haemorrhage, but further research is needed to refine protocols and enhance outcomes in this high-stakes domain.
不可压缩性出血（NCH）的管理仍然是创伤护理中的一项关键挑战，尽管创伤系统有所进步，但早期死亡率一直居高不下。主动脉内复苏性球囊阻断术（REBOA）已成为一种在院前和医院环境中应对严重出血的潜在干预措施。本综述探讨了REBOA在远程损伤控制复苏中的作用，重点关注强调及时干预紧迫性的“黄金一小时”和“白金五分钟”概念。
英国REBOA试验及相关研究的证据凸显了在院前环境中实施REBOA的复杂性，强调了早期部署、合适的患者选择以及减少延误的重要性。技术创新，包括人工智能辅助决策和自动化部分REBOA系统，为优化REBOA的应用提供了有前景的途径。此外，损伤控制院前护理的概念优先考虑根据个体患者需求定制的必要干预措施，提倡采用简化方法以减少现场停留时间。
将REBOA与先进的院前策略相结合有可能减少创伤性出血导致的可预防死亡，但需要进一步研究来完善方案并改善这一高风险领域的治疗效果。
