手术和创伤患者的主动脉复苏性血管内球囊阻断术：来自东部创伤外科学会的系统评价、荟萃分析及实践管理指南
Resuscitative Endovascular Balloon Occlusion of the Aorta in surgical and trauma patients: a systematic review, meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma.
作者信息
Harfouche Melike N, Bugaev Nikolay, Como John J, Fraser Douglas R, McNickle Allison G, Golani Guy, Johnson Benjamin P, Hojman Horacio, Abdel-Aziz Hiba, Sawhney Jaswin S, Cullinane Daniel C, Lorch Steven, Haut Elliott R, Fox Nicole, Magder Laurence S, Kasotakis George
机构信息
Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Division of Trauma & Acute Care Surgery, Tufts Medical Center, Boston, Massachusetts, USA.
出版信息
Trauma Surg Acute Care Open. 2025 Mar 28;10(1):e001730. doi: 10.1136/tsaco-2024-001730. eCollection 2025.
BACKGROUND
The role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the management of patients with subdiaphragmatic bleeding, as well as its utility in traumatic cardiac arrest (TCA), is unknown.
METHODS
A working group from the Eastern Association for the Surgery of Trauma (EAST) applied the Grading of Recommendations Assessment, Development and Evaluation methodology (GRADE) to perform a systematic review and meta-analysis, assess the level of evidence, and create recommendations pertaining to the use of REBOA in the management of trauma or non-trauma patients, as well as those in TCA (1946 to 2024).
RESULTS
Thirty-one studies were included in the meta-analysis. In unstable trauma patients with subdiaphragmatic bleeding, there was no significant difference in mortality among patients who were treated with REBOA vs no REBOA [OR 0.86, 95% CI 0.37, 2.04]. Subgroup analysis for individuals with pelvic fractures demonstrated higher mortality for REBOA vs no REBOA [OR=2.15, CI 1.35, 3.42]. In patients with TCA, pooled analysis demonstrated decreased mortality with REBOA vs resuscitative thoracotomy (OR 0.32, 95% CI 0.15, 0.69). Compared with no REBOA, prophylactic placement of REBOA prior to cesarean section in placenta accreta syndrome (PAS) had lower intra-operative blood loss [-1.06 L, CI -1.57 to -0.56] and red blood cell transfusion [-2.44 units, CI -4.27 to -0.62]. Overall, the level of evidence was assessed by the working group as very low.
CONCLUSION
Considering the risks associated with its use and lack of discernible benefit, the committee conditionally recommends against the use of REBOA in trauma patients who are hemodynamically unstable due to suspected subdiaphragmatic hemorrhage. Further research is needed to identify specific subpopulations who may benefit. For individuals with TCA due to suspected subdiaphragmatic bleeding and for prophylactic placement in PAS, the committee conditionally recommends for the use of REBOA.
LEVEL OF EVIDENCE
IV.
背景
主动脉内复苏球囊阻断术（REBOA）在膈下出血患者管理中的作用及其在创伤性心脏骤停（TCA）中的效用尚不清楚。
方法
东部创伤外科学会（EAST）的一个工作组应用推荐分级评估、制定和评价方法（GRADE）进行系统评价和荟萃分析，评估证据水平，并就REBOA在创伤或非创伤患者以及TCA患者（1946年至2024年）管理中的应用提出建议。
结果
荟萃分析纳入了31项研究。在伴有膈下出血的不稳定创伤患者中，接受REBOA治疗与未接受REBOA治疗的患者死亡率无显著差异[比值比（OR）0.86，95%置信区间（CI）0.37，2.04]。骨盆骨折患者的亚组分析显示，接受REBOA治疗的患者死亡率高于未接受REBOA治疗的患者[OR = 2.15，CI 1.35，3.42]。在TCA患者中，汇总分析显示与复苏性开胸手术相比REBOA可降低死亡率（OR 0.32，95% CI 0.15，0.69）。与未使用REBOA相比，在胎盘植入综合征（PAS）剖宫产术前预防性放置REBOA可减少术中失血量[-1.06 L，CI -1.57至-0.56]和红细胞输注量[-2.44单位，CI -4.27至-0.62]。总体而言，工作组评估证据水平非常低。
结论
考虑到其使用相关风险和缺乏明显益处，委员会有条件地建议不应对因疑似膈下出血而血流动力学不稳定的创伤患者使用REBOA。需要进一步研究以确定可能受益的特定亚组人群。对于因疑似膈下出血导致TCA的患者以及在PAS中进行预防性放置，委员会有条件地建议使用REBOA。
证据水平
IV级
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