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. 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. 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). 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.

中文翻译：

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混合手术室创伤和失血性休克主动脉闭塞后的生存和神经系统结果

主动脉闭塞治疗创伤和失血性休克后的结果很差，导致一些人质疑主动脉闭塞在这种情况下的临床应用。本研究评估了复苏性主动脉血管内球囊闭塞术 (REBOA) 与复苏性开胸术在具有血管造影能力的专用创伤混合手术室的中心的神经完整存活率。这项回顾性队列分析比较了通过复苏开胸术接受 1 区主动脉阻断术 (n = 13) 与 REBOA (n = 13) 的钝性或非胸部、穿透性创伤和难治性失血性休克（收缩压低于 90 毫米汞柱，尽管容积很大）的患者复苏）在具有专用创伤混合手术室的 1 级创伤中心进行。主要结果是出院存活率。次要结果是出院时的神经系统状态，通过格拉斯哥昏迷量表 (GCS) 评分进行评估。总体中位年龄为 40 岁，27% 有穿透伤，23% 有院前胸腔心肺复苏术。在这两个队列中，中位伤害严重程度评分和头部简化伤害评分分别为 26 和 2。复苏开胸队列到达时的收缩压较低（0 [0–75] 与 76 [65–99]，p = 0.009）。77% 的 REBOA 病例和 8% 的复苏性开胸手术病例（p = 0.001）实现了出血控制（收缩压 100 mmHg，无需继续使用血管加压药或输血）。REBOA 队列的出院存活率更高（54% 对 8%，p = 0.030），GCS 15 出院率更高（46% 对 0%，p = 0.015）。在一个有专门的创伤混合手术室的中心接受主动脉闭塞治疗钝性或非胸部、穿透性创伤和难治性失血性休克的患者中，近一半接受 REBOA 治疗的患者在神经系统上存活完好。复苏性开胸术的高死亡率和患者队列的差异限制了直接比较。