Resuscitative endovascular balloon occlusion of the aorta and traumatic out-of-hospital cardiac arrest: A nationwide study.
OHCA
REBOA
aortic occlusion
balloon occlusion
cardiac arrest
mortality
resuscitative thoracotomy
traumatic cardiac arrest
Journal
Journal of the American College of Emergency Physicians open
ISSN: 2688-1152
Titre abrégé: J Am Coll Emerg Physicians Open
Pays: United States
ID NLM: 101764779
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
09
03
2020
revised:
29
04
2020
accepted:
09
06
2020
entrez:
1
10
2020
pubmed:
2
10
2020
medline:
2
10
2020
Statut:
epublish
Résumé
Resuscitative 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. A 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. Among 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). REBOA for t-OHCA was associated with higher survival to discharge. These results should be validated by further research.
Identifiants
pubmed: 33000081
doi: 10.1002/emp2.12177
pii: EMP212177
pmc: PMC7493555
doi:
Types de publication
Journal Article
Langues
eng
Pagination
624-632Informations de copyright
© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.
Déclaration de conflit d'intérêts
The authors have no relevant conflicts of interest to disclose.
Références
Circulation. 2009 Sep 29;120(13):1241-7
pubmed: 19752324
Eur J Trauma Emerg Surg. 2019 Aug;45(4):697-704
pubmed: 29855670
Stat Methods Med Res. 2017 Aug;26(4):1654-1670
pubmed: 25934643
Am J Surg. 2019 Dec;218(6):1162-1168
pubmed: 31540683
Scand J Trauma Resusc Emerg Med. 2019 Aug 16;27(1):74
pubmed: 31420058
J Trauma Acute Care Surg. 2016 Sep;81(3):409-19
pubmed: 27050883
Resuscitation. 2016 Jan;98:79-84
pubmed: 26620392
Injury. 2019 Jun;50(6):1186-1191
pubmed: 31047681
Eur J Trauma Emerg Surg. 2019 Dec;45(6):1097-1105
pubmed: 30032348
JAMA Surg. 2018 Jun 20;153(6):e180674
pubmed: 29710068
Int J Cardiol. 2017 Aug 1;240:438-443
pubmed: 28395982
J Am Coll Surg. 2018 May;226(5):730-740
pubmed: 29421694
J Trauma. 2006 Jun;60(6 Suppl):S3-11
pubmed: 16763478
J Am Coll Surg. 2003 Jan;196(1):106-12
pubmed: 12517561
Resuscitation. 2015 Oct;95:e71-120
pubmed: 26477429
J Trauma Acute Care Surg. 2015 Jul;79(1):159-73
pubmed: 26091330
Ann Emerg Med. 2018 Oct;72(4):354-360
pubmed: 29685373
J Trauma Acute Care Surg. 2013 Sep;75(3):506-11
pubmed: 24089121
J Trauma. 2011 Feb;70(2):334-9
pubmed: 21307731
Surgery. 2011 Sep;150(3):400-9
pubmed: 21878225
J Trauma. 2010 Jun;68(6):1514-5
pubmed: 20539197
Surgery. 2013 Jun;153(6):848-56
pubmed: 23453327
Injury. 2012 Sep;43(9):1355-61
pubmed: 22560130
Ann Emerg Med. 2015 Mar;65(3):297-307.e16
pubmed: 25443990
Multivariate Behav Res. 2011 May;46(3):399-424
pubmed: 21818162
Crit Care. 2012 Jul 06;16(4):R117
pubmed: 22770439
J Trauma Acute Care Surg. 2017 Dec;83(6):1161-1164
pubmed: 29190256
J Trauma Acute Care Surg. 2015 Apr;78(4):721-8
pubmed: 25742248
J Am Coll Surg. 2000 Mar;190(3):288-98
pubmed: 10703853
Resuscitation. 2017 Jan;110:90-94
pubmed: 27855275
J Trauma. 2008 Jan;64(1):1-7; discussion 7-8
pubmed: 18188091