当代使用III区REBOA临时控制骨盆和下交界处出血可靠地实现了严重损伤患者的血液动力学稳定性

IF 0.4 Q4 EMERGENCY MEDICINE

Journal of EndoVascular Resuscitation and Trauma Management Pub Date : 2019-04-25 DOI:10.26676/JEVTM.V3I2.89

J. Pasley

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引用次数: 0

摘要

背景：主动脉闭塞是治疗创伤性骨盆和下肢交界处出血的一种有价值的辅助手段。方法：对来自八个经验证的创伤中心的需要III区复苏性血管内球囊闭塞主动脉（REBOA）的患者的美国创伤外科协会创伤和急性护理外科登记进行审查。在排除停搏患者后，确定了人口统计学、治疗要素和结果。结果：从2013年11月至2016年12月，30名患者接受了III区REOA治疗。中位年龄为41.0岁（IQR 38）；ISS中位数为41.0（IQR 12）。30.0%的患者入院时出现低血压（SBP<90mmHg），66.7%的患者出现心动过速（HR>100bpm）。在放置REBOA之前，该队列的生命体征发生了变化，83.3%的患者出现低血压，90%的患者出现了心动过速。初始pH中位数为7.14（IQR 0.22），入院乳酸中位数为9.9mg/dL（IQR 5）。骨盆粘合剂的使用率为40%。包括Coda的遮挡气球设备™ （70%），再沸器™ （13.3%），信实™ （10%）。REBOA后，血流动力学改善96.7%，稳定性（血压始终>90mmHg）达到86.7%。REBOA的中位持续时间为53.0分钟（IQR 112）。PRBC和FFP要求的中位数分别为19.0个单位（IQR（17）和17.0个单位）。需要进行一次与REBOA利用率无关的截肢手术。系统并发症包括AKI（23.3%）和MODS（10%）。REBOA特异性并发症包括腹股沟血肿（3.3%）和远端血栓栓塞（16.7%）。出院存活率为56.7%，住院死亡发生在ED 7.7%，OR 23.1%，ICU 69.2%。结论：本综述讨论了III区REBOA置入术的当代使用细节，以及盆腔/交界处出血的极端患者的局部和全身并发症。需要进一步审查以确定最佳患者选择。证据级别：IV级研究类型：治疗关键词III区REBOA、骨盆出血、交界处出血

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Contemporary Utilization of Zone III REBOA for Temporary Control of Pelvic and Lower Junctional Hemorrhage Reliably Achieves Hemodynamic Stability in Severely Injured Patients

Background: Aortic occlusion is a valuable adjunct for management of traumatic pelvic and lower extremity junctional hemorrhage. Methods: The American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry was reviewed for patients requiring Zone III resuscitative endovascular balloon occlusion of the aorta (REBOA) from eight verified trauma centers. After excluding patients in arrest, demographics, elements of treatment and outcomes were identified. Results: From Nov 2013 – Dec 2016, 30 patients had Zone III REBOA placed. Median age was 41.0 (IQR 38); median ISS 41.0 (IQR 12). Hypotension (SBP < 90mm Hg) was present on admission in 30.0% and tachycardia (HR > 100 bpm) in 66.7%. Before REBOA placement, vital signs changed in this cohort with hypotension in 83.3% and tachycardia noted in 90%. Median initial pH was 7.14 (IQR 0.22), and median admission lactate 9.9 mg/dL (IQR 5). Pelvic binders were utilized in 40%. Occlusion balloon devices included Coda™ (70%), ER-REBOA™ (13.3%), Reliant™ (10%). After REBOA, hemodynamics improved in 96.7% and stability (BP consistently > 90 mm Hg) was achieved in 86.7%. Median duration of REBOA was 53.0 mins (IQR 112). Median PRBC and FFP requirements were 19.0 units (IQR (17) and 17.0 units (IQR 14), respectively. One amputation unrelated to REBOA utilization was required. Systemic complications included AKI (23.3%) and MODS (10%). REBOA specific complications included groin hematoma (3.3%) and distal thromboembolization (16.7%). Survival to discharge was 56.7%, with in-hospital deaths occurring in the ED 7.7%, OR 23.1%, ICU 69.2%. Conclusions: This review discusses the specifics of the contemporary use of Zone III REBOA placement as well as local and systemic complications for patients in extremis with pelvic/junctional hemorrhage. Further review is required determine optimal patient selection. Level of Evidence: Level IV Study Type: Therapeutic Key Words Zone III REBOA, Pelvic Bleeding, Junctional Hemorrhage

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来源期刊

Journal of EndoVascular Resuscitation and Trauma Management Multiple-

CiteScore

0.60

自引率

25.00%

发文量