Resuscitative endovascular balloon occlusion of the aorta provides better survival outcomes for noncompressible blunt torso bleeding below the diaphragm compared to resuscitative thoracotomy.

Chien-An Liao, Shu-Yi Huang, Chih-Po Hsu, Ya-Chiao Lin, Chi-Tung Cheng, Jen-Fu Huang, Hsi-Hsin Li, Wen-Ya Tung, Yi-Jung Chen, Ken-Hsiung Chen, Shih-Tien Wang
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Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) serves as a bridging intervention for subsequent definitive haemorrhagic control. This study compared the clinical outcomes of REBOA and resuscitative thoracotomy (RT) in patients with bleeding below the diaphragm.

Materials and methods: This retrospective cohort study included adult trauma patients who presented to the Trauma Quality Improvement Program between 2020 and 2021 and who underwent either REBOA or RT in the emergency department (ED). Patients with severe head and chest injuries, characterised by an Abbreviated Injury Scale (AIS) score greater than 3, were excluded. The clinical data of patients treated with REBOA and those treated with RT were compared, and multivariable logistic regression (MLR) was employed to identify prognostic factors associated with mortality.

Results: A total of 346 patients were enrolled: 138 (39.9 %) received REBOA, and 208 (60.1 %) received RT at the ED. Patients in the RT group underwent ED cardiopulmonary resuscitation (CPR) more frequently (58.2 % vs. 23.2 %; p < 0.001) and had a higher mortality rate (87.0 % vs. 45.7 %; p < 0.001). Patients who died had lower Glasgow Coma Scale scores (6 [4.5] vs. 11 [4.9]; p < 0.001), underwent more ED CPR (58.6 % vs. 9.8 %; p < 0.001), and received RT more frequently (74.2 % vs. 26.5 %, p < 0.001). The MLR revealed that the major prognostic factors for mortality were systolic blood pressure (odds ratio [OR] 0.988, 95 % confidence interval [CI] 0.978-0.998; p = 0.014), ED CPR (OR 11.111, 95 % CI 4.667-26.452; p < 0.001), abdominal injuries with an AIS score ≥ 4 (OR 4.694, 95 % CI 1.921-11.467; p = 0.001) and RT (OR 5.693, 95 % CI 2.690-12.050; p < 0.001).

Conclusions: In cases of blunt trauma, prompt identification of the bleeding source is crucial. For patients with bleeding below the diaphragm, REBOA led to higher survival rates than did RT. However, it is important to consider the limitations of the database and the necessary exclusions from our analysis.

与开胸手术相比,抢救性血管内球囊闭塞主动脉可为膈下非压缩性钝性躯干出血患者带来更好的存活效果。
背景:抢救性主动脉血管内球囊闭塞术(REBOA)是随后明确控制出血的桥接干预措施。本研究比较了REBOA和胸廓切开术(RT)对膈下出血患者的临床效果:这项回顾性队列研究纳入了 2020 年至 2021 年期间到创伤质量改进项目就诊、在急诊科(ED)接受 REBOA 或 RT 的成人创伤患者。研究排除了头部和胸部严重受伤的患者,这些患者的简明伤害量表(AIS)评分超过3分。对接受REBOA治疗的患者和接受RT治疗的患者的临床数据进行比较,并采用多变量逻辑回归(MLR)来确定与死亡率相关的预后因素:共有 346 名患者入选:138人(39.9%)接受了REBOA治疗,208人(60.1%)在急诊室接受了RT治疗。RT组患者接受急诊室心肺复苏(CPR)的频率更高(58.2% 对 23.2%;P < 0.001),死亡率更高(87.0% 对 45.7%;P < 0.001)。死亡患者的格拉斯哥昏迷量表评分较低(6 [4.5] vs. 11 [4.9];P < 0.001),接受 ED CPR 的比例较高(58.6 % vs. 9.8 %;P < 0.001),接受 RT 的比例较高(74.2 % vs. 26.5 %;P < 0.001)。MLR 显示,死亡率的主要预后因素是收缩压(几率比 [OR] 0.988,95% 置信区间 [CI] 0.978-0.998;P = 0.014)、急诊室心肺复苏(OR 11.111,95 % CI 4.667-26.452;p < 0.001)、AIS 评分≥ 4 的腹部损伤(OR 4.694,95 % CI 1.921-11.467;p = 0.001)和 RT(OR 5.693,95 % CI 2.690-12.050;p < 0.001):在钝性创伤病例中,及时识别出血源至关重要。对于膈下出血的患者,REBOA的存活率高于RT。然而,考虑到数据库的局限性和我们分析中必要的排除因素也很重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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