Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI).

Autor:	Brenner M; Surgery, University of California Riverside, Riverside, California, USA.; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, California, USA., Zakhary B; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, California, USA., Coimbra R; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, California, USA., Morrison J; Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA., Scalea T; Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA., Moore LJ; Surgery, University of Texas McGovern Medical School, Houston, Texas, USA., Podbielski J; Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA., Holcomb JB; Surgery, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Inaba K; Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA., Cannon JW; Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Seamon M; Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Spalding C; Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA., Fox C; Vascular Surgery, Denver Health and Hospital Authority, Denver, Colorado, USA., Moore EE; Vascular Surgery, Denver Health and Hospital Authority, Denver, Colorado, USA., Ibrahim JA; Surgery, Orlando Regional Medical Center, Orlando, Florida, USA.
Jazyk:	angličtina
Zdroj:	Trauma surgery & acute care open [Trauma Surg Acute Care Open] 2022 Mar 16; Vol. 7 (1), pp. e000715. Date of Electronic Publication: 2022 Mar 16 (Print Publication: 2022).
DOI:	10.1136/tsaco-2021-000715
Abstrakt:	Background: The effects of aortic occlusion (AO) on brain injury are not well defined. We examined the impact of AO by resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative thoracotomy (RT) on outcomes in the setting of traumatic brain injury (TBI). Methods: Patients sustaining TBI who underwent RT or REBOA in zone 1 (thoracic aorta) from September 2013 to December 2018 were identified. The indication for REBOA or RT was hemodynamic collapse due to hemorrhage below the diaphragm. Primary outcomes included mortality and systemic complications. Results: 282 patients underwent REBOA or RT. Of these, 76 had mild TBI (40 REBOA, 36 RT) and 206 sustained severe TBI (107 REBOA, 99 RT). Overall, the mean (±SD) age was 42±17 years, with an Injury Severity Score (ISS) of 40±17 and mean systolic blood pressure (SBP) at the time of REBOA or RT of 81±34 mm Hg. REBOA patients had a mean SBP at the time of AO of 78.39±29.45 mm Hg, whereas RT patients had a mean SBP of 83.18±37.87 mm Hg at the time of AO (p=0.24). 55% had ongoing cardiopulmonary resuscitation (CPR) at the time of AO, and the in-hospital mortality was 86%. Binomial logistic regression controlling for TBI severity, age, ISS, SBP at the time of AO, crystalloid infusion, and CPR during AO demonstrated that the odds of mortality are 3.1 times higher for RT compared with REBOA. No significant differences were found in systemic complications between RT and REBOA. Discussion: Patients with TBI who receive REBOA may have improved survival, but no difference in systemic complications, compared with patients who receive RT for the same indication. Although some patients are receiving RT prior to arrest for extrathoracic hemorrhagic shock, these results suggest that REBOA should be considered as an alternative to RT when RT is chosen for the sole purpose of resuscitation in the setting of TBI. Level of Evidence: 4. Competing Interests: Competing interests: MB, JM, CF: Prytime Medical, Clinical Advisory Board Members. LJM: Frontline Medical, Clinical Advisory Board Member, Consultant. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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