Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in a multidisciplinary approach for management of traumatic haemorrhagic shock: 10-year retrospective experience from a French level 1 trauma centre.

Jonathan Charbit, Geoffrey Dagod, Simon Darcourt, Emmanuel Margueritte, François-Regis Souche, Laurence Solovei, Valérie Monnin-Barres, Ingrid Millet, Xavier Capdevila
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Abstract

Background: The present study investigated an institutional multidisciplinary strategy for managing traumatic haemorrhagic shock by integrating the placement of REBOA (resuscitative endovascular balloon occlusion of the aorta) by anaesthesiologist-intensivists.

Methods: All severe trauma patients who received percutaneous REBOA placement between January 2013 and December 2022 in our level 1 trauma centre were retrospectively analysed. The data collected included the clinical context, indications and location of REBOA, durations of aortic occlusion (AO), choice of haemostatic procedures and surgical teams, and specific complications.

Results: In total, 38 trauma patients were included in the present study (mean age = 41 years [standard deviation = 21 years], 31 [82 %] were male, and median injury severity score was 62.5 [inter-quartile range (IQR) = 45-75]). REBOA was always placed by anaesthesiologist-intensivists, who comprised 68 % of the senior physicians (13/19) in our trauma team over the period. Twenty-eight AOs (74 %) were performed in zone 1 and 10 (26 %) in zone 3. Twelve patients (32 %) received REBOA upon circulatory arrest. Routes following REBOA placement comprised: computed tomography scan = 47 %, operating room = 34 %, angiography = 3 %, emergency room thoracotomy = 5 %, and prematurely died = 11 %. Duration of AO was 38 min (IQR = 32-44 min) in zone 1 and 78 min (IQR = 48-112 min) in zone 3. Mortality rate was 66 % (95 % CI 51-81 %) and higher in cases of AO in zone 1 (79 % versus 30 %, p = 0.018) or concomitant with circulatory arrest (92 % versus 54 %, p = 0.047). No ischemic limb needed an intervention and three endothelial injuries required delayed endovascular stenting.

Conclusions: Percutaneous REBOA placement by anaesthesiologist-intensivists included in the multidisciplinary management of traumatic haemorrhagic shock was associated with acceptable time of AO and local complications similar to those observed in other series.

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在治疗创伤性失血性休克的多学科方法中使用血管内球囊闭塞主动脉复苏术(REBOA):法国一级创伤中心的十年回顾性经验。
背景:本研究探讨了一种由麻醉师和重症监护医师共同实施REBOA(主动脉复苏性血管内球囊闭塞术)治疗创伤性失血性休克的机构多学科策略:方法:对2013年1月至2022年12月期间在本院一级创伤中心接受经皮REBOA置管的所有严重创伤患者进行回顾性分析。收集的数据包括临床背景、REBOA 的适应症和位置、主动脉闭塞(AO)的持续时间、止血程序和手术团队的选择以及具体的并发症:本研究共纳入38名创伤患者(平均年龄=41岁[标准差=21岁],男性31人[82%],受伤严重程度中位数为62.5分[四分位数间距(IQR)=45-75分])。在此期间,REBOA 始终由麻醉师-重症监护医师实施,他们占创伤团队高级医师的 68%(13/19)。28例(74%)在1区进行了AO,10例(26%)在3区进行了AO。12名患者(32%)在循环停止后接受了REBOA。实施REBOA后的途径包括:计算机断层扫描=47%,手术室=34%,血管造影=3%,急诊室开胸术=5%,早逝=11%。AO 持续时间在 1 区为 38 分钟(IQR = 32-44 分钟),在 3 区为 78 分钟(IQR = 48-112 分钟)。死亡率为 66% (95 % CI 51-81%),在 1 区(79% 对 30%,p = 0.018)或同时出现循环骤停时(92% 对 54%,p = 0.047),AO 死亡率更高。没有缺血肢体需要介入治疗,有三处内皮损伤需要延迟血管内支架置入:结论:在创伤性失血性休克的多学科治疗中,由麻醉师和重症监护医师经皮置入REBOA与可接受的AO时间和局部并发症有关,与其他系列观察到的情况相似。
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