利用表型分析优化主动脉复苏性血管内球囊阻断术的效果：一项全国性研究。
Optimizing resuscitative endovascular balloon occlusion of the aorta outcomes using phenotype analysis: A nationwide study.
作者信息
Yamamoto Ryo, Liao Lillian, Dent Daniel L, Nicholson Susannah E, Eastridge Brian J, Stewart Ronald M, Yajima Keitaro, Endo Akia, Yamakawa Kazuma, Sasaki Junichi
机构信息
From the Department of Emergency and Critical Care Medicine (R.Y., K.Y., J.S.), Keio University School of Medicine, Tokyo, Japan; Department of Surgery (L.L., D.L.D., S.E.N., B.J.E., R.M.S.), UT Health San Antonio, San Antonio, Texas; Department of Acute Critical Care Medicine (A.E.), Tsuchiura Kyodo General Hospital, Ibaraki; and Department of Emergency and Critical Care Medicine (K.Y.), Osaka Medical and Pharmaceutical University, Osaka, Japan.
出版信息
J Trauma Acute Care Surg. 2025 Oct 1;99(4):611-618. doi: 10.1097/TA.0000000000004703. Epub 2025 Jul 3.
BACKGROUND
We aimed to identify clinical features of patients who most benefitted from resuscitative endovascular balloon occlusion of the aorta (REBOA).
METHODS
Adult patients treated with REBOA were identified in the Japan Trauma Data Bank (2019-2022), and phenotype analyses were conducted. An estimated survival rate was calculated for each patient treated with REBOA adjusting for background and institution characteristics, which was compared with a general probability of survival calculated with Trauma and Injury Severity Score probability of survival. Patients were divided into four groups: notably higher, higher, notably lower, and lower survival than expected (>15% higher, 0-15% higher, ≥15% lower, and 0-15% lower than Trauma and Injury Severity Score probability of survival, respectively) groups. Then, clinical features were identified in patients with notably higher survival as significantly inclining/declining variables across the groups. In the validation using 2010 to 2018 database, patients with these clinical features were selected, and in-hospital survival was compared between those with and without REBOA.
RESULTS
Among 805 patients treated with REBOA, 180 (22.4%) had notably higher, and 240 (29.8%) had higher survival than expected. Glasgow Coma Scale score of ≤6, systolic blood pressure of ≤70 mm Hg, Abbreviated Injury Scale (AIS) in abdomen score of ≥3, and AIS in extremity/pelvis score of ≥4 were identified as the clinical features of patients with notably higher survival than expected. In the validation, 236 patients met all the identified features, and those with REBOA showed higher survival to discharge than those without (8/39 [21.6%] vs. 13/197 [7.3%]; odds ratio, 3.52 [1.34-9.25]) and more frequently underwent laparotomy and angiography for pelvis (odds ratio, 2.52 [1.24-5.11] and 2.31 [1.08-4.95], respectively).
CONCLUSION
Patients with Glasgow Coma Scale score of ≤6, systolic blood pressure of ≤70 mm Hg, AIS in abdomen score of ≥3, and AIS in extremity/pelvis score of ≥4 were most likely to benefit from REBOA and had a higher survival rate by >30% than general trauma population treated without REBOA.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
背景
我们旨在确定从主动脉复苏性血管内球囊阻断术（REBOA）中获益最大的患者的临床特征。
方法
在日本创伤数据库（2019 - 2022年）中识别接受REBOA治疗的成年患者，并进行表型分析。对每位接受REBOA治疗的患者，根据背景和机构特征调整后计算估计生存率，并与通过创伤和损伤严重程度评分生存概率计算出的总体生存概率进行比较。患者分为四组：生存率显著高于预期、高于预期、显著低于预期和低于预期（分别比创伤和损伤严重程度评分生存概率高>15%、高0 - 15%、低≥15%和低0 - 15%）组。然后，将生存率显著较高组的患者中作为各分组间显著上升/下降变量的临床特征识别出来。在使用2010年至2018年数据库进行的验证中，选择具有这些临床特征的患者，比较接受REBOA和未接受REBOA患者的院内生存率。
结果
在805例接受REBOA治疗的患者中，180例（22.4%）生存率显著高于预期，240例（29.8%）生存率高于预期。格拉斯哥昏迷量表评分≤6、收缩压≤70 mmHg、腹部简明损伤量表（AIS）评分≥3以及四肢/骨盆AIS评分≥4被确定为生存率显著高于预期患者的临床特征。在验证中，236例患者符合所有确定的特征，接受REBOA治疗的患者出院生存率高于未接受治疗的患者（8/39 [21.6%] 对 13/197 [7.3%]；比值比，3.52 [1.34 - 9.25]），并且接受剖腹手术和骨盆血管造影的频率更高（比值比分别为2.52 [1.24 - 5.11] 和2.31 [1.08 - 4.95]）。
结论
格拉斯哥昏迷量表评分≤6、收缩压≤70 mmHg、腹部AIS评分≥3以及四肢/骨盆AIS评分≥4的患者最有可能从REBOA中获益，其生存率比未接受REBOA治疗的一般创伤人群高>30%。
证据水平
治疗/护理管理；三级。
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