Effectiveness of the Intrauterine Balloon Tamponade Compared With an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device for Postpartum Hemorrhage.

IF 8.3 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY

ACS Applied Materials & Interfaces Pub Date : 2024-10-24 DOI:10.1097/aog.0000000000005770

Laurence E Shields,Catherine Klein,Jennie Torti,Mindy Foster,Curtis Cook

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Abstract

OBJECTIVE To compare intrauterine balloon tamponade and vacuum-induced hemorrhage-control devices in a multicenter hospital system using a standardized three-stage postpartum hemorrhage response algorithm. METHODS As part of a quality improvement project, data were prospectively collected through ongoing detailed hemorrhage case audits from 65 facilities from August 2022 to February 2024. Postpartum hemorrhage-control devices are recommended for stage 2 or 3 of the postpartum hemorrhage algorithm. The primary outcomes were 1) quantitative blood loss after device placement, 2) rate of packed red blood cell (RBC) transfusion, 3) use of 3 units of packed RBCs or more, and 4) device failure. RESULTS During the 17-month observation period, there were 123,292 deliveries, and postpartum hemorrhage occurred in 5,931 (4.8%). Postpartum hemorrhage-control devices were used in 11.2% of cases (666 total, intrauterine balloon tamponade n=300, and vacuum-induced hemorrhage control n=366). For intrauterine balloon tamponade and vacuum-induced hemorrhage-control devices, quantitative blood loss (median and interquartile range) after device placement was similar at 194 (67-440) mL and 240 (113-528) mL (P=.40), respectively, as was the rate of any packed RBC transfusion (59.7% vs 50.0%, P=.08), transfusion of 3 packed RBC units or more (27.0% vs 24.9%, P=.53), and device failure (7.7% vs 8.5%, P=.70). Placement of either device at a quantitative blood loss between 1,000 and 1,499 mL compared with 1,500 mL or more resulted in significantly lower rates of packed RBC transfusion (39.1% vs 70.3%, P<.001), transfusion of 3 or more packed RBC units (13.7 vs 38.1%, P<.001), and device failure (3.4% vs 12.9%, P<.001). CONCLUSION Transfusion and blood loss after device placement were similar with both hemorrhage-control devices. Earlier hemorrhage-control device placement reduced device failure and the need for transfusion.

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宫腔内球囊填塞术与宫腔内真空止血装置对产后出血的疗效比较。

方法作为质量改进项目的一部分，从 2022 年 8 月到 2024 年 2 月，通过对 65 家医院持续进行详细的出血病例审核，前瞻性地收集了数据。产后出血控制设备被推荐用于产后出血算法的第二或第三阶段。主要结果为：1）装置置入后的定量失血；2）包装红细胞（RBC）输血率；3）使用 3 个单位或更多包装红细胞；4）装置故障。结果在 17 个月的观察期内，共有 123,292 例分娩，5,931 例（4.8%）发生产后出血。11.2%的病例使用了产后出血控制设备（共666例，宫内球囊填塞300例，真空诱导出血控制366例）。对于宫腔内球囊填塞和真空诱导出血控制装置，置入装置后的定量失血量（中位数和四分位间范围）相似，分别为 194（67-440）毫升和 240（113-528）毫升（P=.40），输注任何包装红细胞的比例（59.7% vs 50.0%，P=.08）、输注 3 个或更多包装红细胞单位的比例（27.0% vs 24.9%，P=.53）和装置失效的比例（7.7% vs 8.5%，P=.70）也相似。与 1500 毫升或以上的定量失血量相比，在定量失血量介于 1000 到 1499 毫升之间时置入任何一种装置，都能显著降低充盈红细胞输血率（39.1% vs 70.3%，P<.001）、3 个或更多充盈红细胞单位输血率（13.7 vs 38.1%，P<.001）和装置故障率（3.4% vs 12.9%，P<.001）。较早放置出血控制装置可减少装置故障和输血需求。

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来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.