Spence Samantha, Fox Jennifer, Hoag Thomas P, Yeager Madison, Schroll Claire, Koch Thomas, Rudder William, Whalen Matthew, Alshekhlee Dana, Miyamoto Blake, Fan Diana, Sandoval Christopher, Okeke Raymond I, Culhane John
Department of Trauma Surgery, Saint Louis University School of Medicine, St. Louis, USA.
Department of Surgery/Emergency Medicine, Sisters of St. Mary (SSM) Health Saint Louis University Hospital, St. Louis, USA.
Cureus. 2025 Mar 7;17(3):e80210. doi: 10.7759/cureus.80210. eCollection 2025 Mar.
This study aimed to compare the mortality of resuscitative endovascular balloon occlusion of the aorta (REBOA) with emergency department thoracotomy (EDT) and nonprocedural resuscitation (NPR) in the initial resuscitation of life-threatening acute traumatic hemorrhage.
We performed a retrospective chart review of all patients who presented at a single urban level I trauma center with noncompressible torso hemorrhage between January 1, 2012, and October 31, 2022. Patients with a life-threatening injury (Abbreviated Injury Scale score >3) involving significant bleeding in the thorax or abdomen were included. Exclusion criteria were life-threatening head injury and mechanism of ground-level fall. Patients were classified according to the primary means of resuscitation: EDT, REBOA, or blood products and fluid (hemostatic resuscitation) without procedural intervention. The primary outcome was in-hospital mortality. Univariate and multivariate analyses were performed. Covariates included patient demographics, mechanism of injury, and injury severity.
Two hundred sixty-seven cases met the criteria for inclusion. Initial resuscitation was EDT for 71 patients, REBOA for 17, and hemostatic resuscitation only for 179. Mortality rates for EDT compared to REBOA were 64 (90.1%) vs. 10 (58.8%) (p = 0.0051). The adjusted odds ratio (OR) was 0.09 (p = 0.009). The mortality rate for hemostatic resuscitation alone was 41 (22.9%) (p < 0.001) with an OR of 0.02 compared with those who received either EDT or REBOA. This finding remained significant when REBOA and conservative management were compared directly, excluding EDT patients (p = 0.0033).
Mortality associated with EDT is higher than that of REBOA. Mortality for both is higher than nonprocedural hemostatic resuscitation. REBOA is an appropriate salvage maneuver for patients with life-threatening abdominopelvic hemorrhage. However, our results do not support liberalizing its indications to patients responsive to hemostatic resuscitation.
本研究旨在比较在危及生命的急性创伤性出血初始复苏中，复苏性血管内主动脉球囊阻断术（REBOA）与急诊开胸手术（EDT）及非手术复苏（NPR）的死亡率。
我们对2012年1月1日至2022年10月31日期间在一家城市一级创伤中心就诊的所有因不可压缩性躯干出血的患者进行了回顾性病历审查。纳入标准为有危及生命的损伤（简明损伤定级标准评分>3）且胸部或腹部有大量出血的患者。排除标准为危及生命的头部损伤和地面坠落机制。患者根据主要复苏方式分类：EDT、REBOA或无手术干预的血液制品和液体（止血复苏）。主要结局为院内死亡率。进行了单因素和多因素分析。协变量包括患者人口统计学、损伤机制和损伤严重程度。
267例病例符合纳入标准。初始复苏采用EDT的有71例患者，采用REBOA的有17例，仅采用止血复苏的有179例。EDT与REBOA的死亡率分别为64例（90.1%）和10例（58.8%）（p = 0.0051）。调整后的优势比（OR）为0.09（p =
