Critical systolic blood pressure threshold for endovascular aortic occlusion: A multinational analysis to determine when to place a REBOA

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Critical systolic blood pressure threshold for endovascular aortic occlusion : A multinational analysis to determine when to place a REBOA

Ordoñez, Carlos A. (författare): Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, Florida, USA

Parra, Michael W. (författare): Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, Florida, USA

Caicedo, Yaset (författare): Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

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Rodríguez-Holguín, Fernando (författare): Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

García, Alberto F. (författare): Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

Serna, José J. (författare): Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

Serna, Carlos (författare): Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

Franco, María Josefa (författare): Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

Salcedo, Alexander (författare): Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

Padilla-Londoño, Natalia (författare): Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

Herrera-Escobar, Juan P. (författare): Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA

Zogg, Cheryl (författare): Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA

Orlas, Claudia P. (författare): Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA

Palacios, Helmer (författare): Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

Saldarriaga, Luis (författare): Universidad Icesi, Cali, Colombia

Granados, Marcela (författare): Department of Intensive Care, Fundación Valle del Lili, Cali, Colombia

Scalea, Thomas (författare): R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA

McGreevy, David, 1988- (författare): Örebro universitet,Institutionen för medicinska vetenskaper,Department of Cardiothoracic and Vascular Surgery and Department of Surgery

Kessel, Boris (författare): Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel

Hörer, Tal M., 1971- (författare): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Cardiothoracic and Vascular Surgery and Department of Surgery

Dubose, Joseph (författare): Dell School of Medicine, University of Texas, Austin, Texas, USA

Brenner, Megan (författare): Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

AAST-AORTA Investigators, - (bidragsgivare)

ABO Trauma Registry Group, - (bidragsgivare)

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Lippincott Williams & Wilkins, 2024
2024
Engelska.
Ingår i: Journal of Trauma and Acute Care Surgery. - : Lippincott Williams & Wilkins. - 2163-0755 .- 2163-0763. ; 96:2, s. 247-255

Relaterad länk:: https://urn.kb.se/re...; visa fler...; https://doi.org/10.1...; visa färre...

Tidskriftsartikel (refereegranskat)

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BACKGROUND: Systolic blood pressure (SBP) is a potential indicator that could guide when to use a resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma patients with life-threatening injuries. This study aims to determine the optimal SBP threshold for REBOA placement by analyzing the association between SBP pre-REBOA and 24-hour mortality in severely injured hemodynamically unstable trauma patients.METHODS: We performed a pooled analysis of the Aortic Balloon Occlusion (ABO) trauma and AORTA registries. These databases record the details related to the use of REBOA and include data from 14 countries worldwide. We included patients who had suffered penetrating and/or blunt trauma. Patients who arrived at the hospital with a SBP pre-REBOA of 0 mm Hg and remained at 0 mm Hg after balloon inflation were excluded. We evaluated the impact that SBP pre-REBOA had on the probability of death in the first 24 hours.RESULTS: A total of 1107 patients underwent endovascular aortic occlusion, of these, 848 met inclusion criteria. The median age was 44 years [IQR, 27-59 years] and 643(76%) were male. The median injury severity score was 34 [IQR, 25-45]. The median SBP pre-REBOA was 65 mm Hg [IQR: 49-88 mm Hg]. Mortality at 24-hours was reported in 279 (32%) patients. Math modelling shows that predicted probabilities of the primary outcome increased steadily in SBP pre-REBOA below 100 mm Hg. Multivariable mixed-effects analysis shows that when SBP pre-REBOA was lower than 60 mm Hg, the risk of death was more than 50% (relative risk, 1.5; 95%CI, 1.17-1.92; P = .001).DISCUSSION: In patients who do not respond to initial resuscitation, the use of REBOA in SBP's between 60- and 80-mm Hg may be a useful tool in resuscitation efforts before further decompensation or complete cardiovascular collapse. The findings from our study are clinically important as a first step in identifying candidates for REBOA.STUDY TYPE: Observational Study. LEVEL OF EVIDENCE: Level IV.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

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Critical systolic blood pressure threshold for endovascular aortic occlusion : A multinational analysis to determine when to place a REBOA

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