Clinicaleffects of emergency bedside resuscitation balloon occlusion of abdominal aorta technique in patients with severe trauma

doi:10.3877/cma.j.issn.2095-9133.2023.01.007

Abstract

Abstract:

Objective

To study the clinical effect of emergency implementation of resuscitation balloon occlusion of abdominal aorta (REBOA) technique at the bedside in patients with hemodynamics instability of pelvic fractures and/or lower extremity destructive injuries.

Methods

Patients with hemorrhagic shock with pelvic fracture and/or lower limb destruction injury as the main bleeding site admitted to the emergency room of the Second Affiliated Hospital of Nantong University from January 2018 to December 2019 were selected as the research subjects. There were 10 cases in the REBOA group (REBOA was performed at the emergency bedside)and 13 cases in the control group (the emergency bedside REBOA could not be performed for various reasons but damage control surgery was performed). The blood pressure, infusion volume, vasoactive drug usage, and the variability of the inferior vena cava measured by ultrasound were observed at the multiple time points including 1, 2 h after entering the emergency room, before transferring to the operating room, within 6 h after control surgery, before and after REBOA in the study group. And 6, 24h and 7d mortality was also recorded.

Results

The blood pressure of the patients in the REBOA group increased significantly immediately after the implementation of REBOA, compared with that before the implementation of REBOA (P<0.05); At 1 h after the patients entered the emergency room, the doses of dopamine and norepinephrine in the REBOA group at each time point after REBOA were significantly decreased compared with the control group (P<0.05); compared with the control group, in the REBOA group, the blood transfusion volume of the two groups of patients within 6h after receiving the controlled operation was significantly reduced (P<0.05). There was no significant difference in mortality at 6, 24 h and 7 days between the two groups.

Conclusion

Urgent implementation of REBOA can quickly reduce bleeding, restore blood volume and increase blood pressure in a short time in the emergency treatment of patients with hemodynamics instability of pelvic fractures and lower extremity destructive injuries.

Key words: Resuscitation balloon occlusion of abdominal aorta, Severe trauma, Emergency, Bedside ultrasound

Feng Li, Feng Qi, Zhibing Ming, Jie Jin, Ying Liu, Zhihe Tang, Peng Gu. Clinicaleffects of emergency bedside resuscitation balloon occlusion of abdominal aorta technique in patients with severe trauma[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2023, 09(01): 35-40.

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URL: https://zhwsyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9133.2023.01.007

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Figures/Tables 5

References 26

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组别	例数	年龄	性别(男性/女性)	RTS	入ED时SBP(mmHg)	入ED时DBP(mmHg)	入ED时MAP(mmHg)	入ED时Hr
REBOA组	10	56.4±9.3	5/5	7.2±2.4	75.6±8.1	39.3±8.5	45.7±13.6	131.6±32.5
对照组	13	60.9±7.9	8/5	6.8±2.0	73.4±5.4	37.1±10.4	47.5±8.4	140.3±29.8
t值		－1.26	－	0.44	0.78	0.54	－0.39	－0.67
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	年龄	性别(男性/女性)	RTS	入ED时SBP(mmHg)	入ED时DBP(mmHg)	入ED时MAP(mmHg)	入ED时Hr
REBOA组	10	56.4±9.3	5/5	7.2±2.4	75.6±8.1	39.3±8.5	45.7±13.6	131.6±32.5
对照组	13	60.9±7.9	8/5	6.8±2.0	73.4±5.4	37.1±10.4	47.5±8.4	140.3±29.8
t值		－1.26	－	0.44	0.78	0.54	－0.39	－0.67
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

项目	SBP	DBP	MAP
实施前	69.3±11.1	33.6±9.5	44.5±14.7
实施后5 min	98.0±22.5	42.9±11.2	67.4±13.5
t值	5.48	6.00	14.24
P值	<0.01	>0.01	<0.01

项目	SBP	DBP	MAP
实施前	69.3±11.1	33.6±9.5	44.5±14.7
实施后5 min	98.0±22.5	42.9±11.2	67.4±13.5
t值	5.48	6.00	14.24
P值	<0.01	>0.01	<0.01

组别	例数	入ED后1 h			入ED后2 h			入DSA时
组别	例数	SBP	DBP	MAP	SBP	DBP	MAP	SBP	DBP	MAP
REBOA组	10	87.1±13.5	44.9±8.7	63.2±10.3	89.5±12.3	51.8±10.4	65.7±8.5	86.9±15.3	46.6±9.5	60.5±8.9
对照组	13	85.6±18.1	39.8±14.5	59.7±9.9	85.2±14.3	47.4±15.1	57.6±11.9	89.7±19.7	53.4±14.1	55.4±11.2
t值		0.22	0.98	0.83	0.76	0.79	1.82	－0.37	－1.31	1.18
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

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