Resuscitative endovascular balloon occlusion of the aorta and traumatic out-of-hospital cardiac arrest: A nationwide study
Resuscitative endovascular balloon occlusion of the aorta and traumatic out-of-hospital cardiac arrest: A nationwide study
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DOI：
10.1002/emp2.12177
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发表时间：
2020-08-01
影响因子：
2.3
通讯作者：
Sasaki, Junichi
中科院分区：
文献类型：
--
作者：
Yamamoto, Ryo;Suzuki, Masaru;Sasaki, Junichi
与通过复苏性开胸术（RT）交叉夹闭主动脉相比，主动脉复苏性血管内球囊闭塞（REBOA）是一种创伤较小的临时止血方法。虽然REBOA的生存益处尚不清楚，但在创伤性院外心脏骤停（t-OHCA）患者中发现了病理生理学益处。我们研究了t-OHCA的临床结局，假设REBOA与RT相比具有更高的生存率。使用日本创伤数据库（2004-2019年）进行了回顾性队列研究。纳入了未触及脉搏并接受主动脉闭塞的t-OHCA成人患者。将患者分为REBOA或RT组，并使用年龄、损伤机制、生命体征的存在、严重头部和/或胸部损伤的存在、损伤严重程度评分和运输时间进行倾向评分。逆概率加权的倾向得分进行比较生存出院between 2 groups.ResultsAmong 13，247 t-OHCA患者，1483被纳入本研究。共有144例（9.7%）患者接受了REBOA治疗，REBOA组144例患者中有5例（3.5%）和RT组1339例患者中有10例（0.7%）存活至出院。REBOA的使用与出院生存率的增加显著相关（比值比，4.78; 95%置信区间，1.61-14.19），这是由逆概率加权证实（调整后的比值比，3.73; 95%置信区间，1.90-7.32）。这些结果应通过进一步的研究来验证。
ObjectiveResuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive method for temporary hemostasis compared with cross-clamping the aorta through resuscitative thoracotomy (RT). Although the survival benefits of REBOA remained unclear, pathophysiological benefits were identified in patients with traumatic out-of-hospital cardiac arrest (t-OHCA). We examined the clinical outcomes of t-OHCA with the hypothesis that REBOA would be associated with higher survival to discharge compared with RT.MethodsA retrospective cohort study was conducted using the Japan Trauma Data Bank (2004-2019). Adult patients with t-OHCA who had arrived without a palpable pulse and undergone aortic occlusion were included. Patients were divided into REBOA or RT groups, and propensity scores were developed using age, mechanism of injury, presence of signs of life, presence of severe head and/or chest injury, Injury Severity Score, and transportation time. Inverse probability weighting by propensity scores was performed to compare survival to discharge between the 2 groups.ResultsAmong 13,247 patients with t-OHCA, 1483 were included in this study. A total of 144 (9.7%) patients were treated with REBOA, and 5 of 144 (3.5%) in the REBOA group and 10 of 1339 (0.7%) in the RT group survived to discharge. The use of REBOA was significantly associated with increased survival to discharge (odds ratio, 4.78; 95% confidence interval, 1.61-14.19), which was confirmed by inverse probability weighting (adjusted odds ratio, 3.73; 95% confidence interval, 1.90-7.32).ConclusionsREBOA for t-OHCA was associated with higher survival to discharge. These results should be validated by further research.