混合手术室中创伤和失血性休克主动脉闭塞后的生存和神经预后。

IF 6 1区 医学 Q1 EMERGENCY MEDICINE World Journal of Emergency Surgery Pub Date : 2023-03-23 DOI:10.1186/s13017-023-00484-w
Jeremy A Balch, Tyler J Loftus, Philip A Efron, Alicia M Mohr, Gilbert R Upchurch, R Stephen Smith
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引用次数: 1

摘要

背景:创伤和失血性休克后主动脉闭塞的预后很差,导致一些人质疑主动脉闭塞在这种情况下的临床应用。本研究评估复苏血管内球囊闭塞主动脉(REBOA)与复苏开胸手术后的神经系统完整生存率,该中心有专门的创伤混合手术室,具有血管造影能力。方法:本回顾性队列分析比较了在有专门创伤混合手术室的一级创伤中心,通过复苏开胸术(n = 13)和REBOA (n = 13)治疗钝性或非胸部、穿透性创伤和难治性失血性休克(尽管进行了体积复苏,收缩压仍低于90 mmHg)的1区主动脉闭塞患者。主要终点是存活至出院。次要终点是出院时的神经系统状态,由格拉斯哥昏迷量表(GCS)评分评估。结果:总体中位年龄为40岁,27%有穿透性损伤,23%有院前闭胸心肺复苏。在这两个队列中,损伤严重程度评分和头部缩短损伤评分的中位数分别为26分和2分。复苏开胸组患者到达时收缩压较低(0 [0-75]vs. 76 [65-99], p = 0.009)。77%的REBOA病例和8%的复苏开胸病例获得了出血控制(收缩压100 mmHg,不需要持续的血管加压或输血)(p = 0.001)。REBOA组到出院的生存率更高(54%比8%,p = 0.030), GCS 15组出院的生存率更高(46%比0%,p = 0.015)。结论:在一个有专门创伤混合手术室的中心,因钝性或非胸性、穿透性创伤和难治性失血性休克而接受主动脉闭塞手术的患者中,近一半接受REBOA治疗的患者神经功能完好。复苏开胸术的高死亡率和患者队列的差异限制了直接比较。
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Survival and neurologic outcomes following aortic occlusion for trauma and hemorrhagic shock in a hybrid operating room.

Background: Outcomes following aortic occlusion for trauma and hemorrhagic shock are poor, leading some to question the clinical utility of aortic occlusion in this setting. This study evaluates neurologically intact survival following resuscitative endovascular balloon occlusion of the aorta (REBOA) versus resuscitative thoracotomy at a center with a dedicated trauma hybrid operating room with angiographic capabilities.

Methods: This retrospective cohort analysis compared patients who underwent zone 1 aortic occlusion via resuscitative thoracotomy (n = 13) versus REBOA (n = 13) for blunt or non-thoracic, penetrating trauma and refractory hemorrhagic shock (systolic blood pressure less than 90 mmHg despite volume resuscitation) at a level 1 trauma center with a dedicated trauma hybrid operating room. The primary outcome was survival to hospital discharge. The secondary outcome was neurologic status at hospital discharge, assessed by Glasgow Coma Scale (GCS) scores.

Results: Overall median age was 40 years, 27% had penetrating injuries, and 23% had pre-hospital closed-chest cardiopulmonary resuscitation. In both cohorts, median injury severity scores and head-abbreviated injury scores were 26 and 2, respectively. The resuscitative thoracotomy cohort had lower systolic blood pressure on arrival (0 [0-75] vs. 76 [65-99], p = 0.009). Hemorrhage control (systolic blood pressure 100 mmHg without ongoing vasopressor or transfusion requirements) was obtained in 77% of all REBOA cases and 8% of all resuscitative thoracotomy cases (p = 0.001). Survival to hospital discharge was greater in the REBOA cohort (54% vs. 8%, p = 0.030), as was discharge with GCS 15 (46% vs. 0%, p = 0.015).

Conclusions: Among patients undergoing aortic occlusion for blunt or non-thoracic, penetrating trauma and refractory hemorrhagic shock at a center with a dedicated, trauma hybrid operating room, nearly half of all patients managed with REBOA had neurologically intact survival. The high death rate in resuscitative thoracotomy and differences in patient cohorts limit direct comparison.

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来源期刊
World Journal of Emergency Surgery
World Journal of Emergency Surgery EMERGENCY MEDICINE-SURGERY
CiteScore
14.50
自引率
5.00%
发文量
60
审稿时长
10 weeks
期刊介绍: The World Journal of Emergency Surgery is an open access, peer-reviewed journal covering all facets of clinical and basic research in traumatic and non-traumatic emergency surgery and related fields. Topics include emergency surgery, acute care surgery, trauma surgery, intensive care, trauma management, and resuscitation, among others.
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