Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study.
Abdominal Injuries
/ complications
Adult
Aged
Algorithms
Aorta
Balloon Occlusion
/ methods
Clinical Decision-Making
/ methods
Emergency Medical Services
/ methods
Endovascular Procedures
Female
Fractures, Bone
/ complications
Heart Arrest
/ etiology
Hemorrhage
/ etiology
Humans
Logistic Models
Male
Middle Aged
Pelvic Bones
/ injuries
Resuscitation
/ methods
Retrospective Studies
Journal
Journal of the American College of Surgeons
ISSN: 1879-1190
Titre abrégé: J Am Coll Surg
Pays: United States
ID NLM: 9431305
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
05
04
2019
revised:
14
05
2019
accepted:
20
05
2019
pubmed:
9
6
2019
medline:
22
5
2020
entrez:
9
6
2019
Statut:
ppublish
Résumé
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used as part of damage control resuscitation for patients with non-compressible truncal hemorrhage. We hypothesized that there might be a select group of patients that could have benefited from prehospital placement of the REBOA. This was a retrospective cohort study including patients who presented to a Level I trauma center with cardiac arrest between January 2014 and March 2018. The findings of a full autopsy were reviewed for the details of internal injuries. A patient was determined to be a REBOA candidate if the patient sustained abdominal organ injuries or pelvic fractures and no associated severe head injuries. The candidate group was compared with the non-candidate group based on prehospital vital signs and other patient characteristics. A multiple logistic regression analysis was performed to identify certain prehospital factors associated with candidacy for prehospital REBOA. A total of 198 patients met our inclusion criteria. Of those, 27 (13.6%) patients were deemed REBOA candidates. Median Injury Severity Score was 22 (interquartile range 17 to 29). Patients in the candidate group were more likely to have a Glasgow Coma Scale score ≥9 (48% vs 15%; p = 0.012), oxygen saturation >90% (56% vs 35%; p = 0.03), and systolic blood pressure <90 mmHg (48% vs 26%; p = 0.04) in the field. Logistic regression showed that these 3 clinical parameters of prehospital vital signs were significantly associated with REBOA candidacy. Our data suggest that >10% of trauma patients who presented with cardiac arrest could have benefited from prehospital REBOA. Additional prospective studies are warranted to validate the use of field vital signs in selecting candidates.
Sections du résumé
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used as part of damage control resuscitation for patients with non-compressible truncal hemorrhage. We hypothesized that there might be a select group of patients that could have benefited from prehospital placement of the REBOA.
STUDY DESIGN
This was a retrospective cohort study including patients who presented to a Level I trauma center with cardiac arrest between January 2014 and March 2018. The findings of a full autopsy were reviewed for the details of internal injuries. A patient was determined to be a REBOA candidate if the patient sustained abdominal organ injuries or pelvic fractures and no associated severe head injuries. The candidate group was compared with the non-candidate group based on prehospital vital signs and other patient characteristics. A multiple logistic regression analysis was performed to identify certain prehospital factors associated with candidacy for prehospital REBOA.
RESULTS
A total of 198 patients met our inclusion criteria. Of those, 27 (13.6%) patients were deemed REBOA candidates. Median Injury Severity Score was 22 (interquartile range 17 to 29). Patients in the candidate group were more likely to have a Glasgow Coma Scale score ≥9 (48% vs 15%; p = 0.012), oxygen saturation >90% (56% vs 35%; p = 0.03), and systolic blood pressure <90 mmHg (48% vs 26%; p = 0.04) in the field. Logistic regression showed that these 3 clinical parameters of prehospital vital signs were significantly associated with REBOA candidacy.
CONCLUSIONS
Our data suggest that >10% of trauma patients who presented with cardiac arrest could have benefited from prehospital REBOA. Additional prospective studies are warranted to validate the use of field vital signs in selecting candidates.
Identifiants
pubmed: 31176027
pii: S1072-7515(19)30365-5
doi: 10.1016/j.jamcollsurg.2019.05.025
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
383-388.e1Informations de copyright
Copyright © 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.