Y Matsumura1,2, J Matsumoto3, K Idoguchi4, H Kondo5, T Ishida6, Y Kon7, K Tomita8, K Ishida9, T Hirose10, K Umakoshi11, T Funabiki12. 1. R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA. yousuke.jpn4035@gmail.com. 2. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan. yousuke.jpn4035@gmail.com. 3. Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan. 4. Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Osaka, Japan. 5. Department of Radiology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan. 6. Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan. 7. Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Aomori, Japan. 8. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan. 9. Department of Acute Medicine and Critical Care Medical Center, National Hospital Organization, Osaka National Hospital, Osaka, Osaka, Japan. 10. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. 11. Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Matsuyama, Ehime, Japan. 12. Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan.
Abstract
PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is now a feasible and less invasive resuscitation procedure. This study aimed to compare the clinical course of trauma and non-trauma patients undergoing REBOA. METHODS: Patient demographics, etiology, bleeding sites, hemodynamic response, length of critical care, and cause of death were recorded. Characteristics and outcomes were compared between non-trauma and trauma patients. Kaplan-Meier survival analysis was then conducted. RESULTS: Between August 2011 and December 2015, 142 (36 non-trauma; 106 trauma) cases were analyzed. Non-traumatic etiologies included gastrointestinal bleeding, obstetrics and gynecology-derived events, visceral aneurysm, abdominal aortic aneurysm, and post-abdominal surgery. The abdomen was a common bleeding site (69%), followed by the pelvis or extra-pelvic retroperitoneum. None of the non-trauma patients had multiple bleeding sites, whereas 45% of trauma patients did (P < 0.001). No non-trauma patients required resuscitative thoracotomy compared with 28% of the trauma patients (P < 0.001). Non-trauma patients presented a lower 24-h mortality than trauma patients (19 vs. 51%, P = 0.001). The non-trauma cases demonstrated a gradual but prolonged increased mortality, whereas survival in trauma cases rapidly declined (P = 0.009) with similar hospital mortality (68 vs. 64%). Non-trauma patients who survived for 24 h had 0 ventilator-free days and 0 ICU-free days vs. a median of 19 and 12, respectively, for trauma patients (P = 0.33 and 0.39, respectively). Non-hemorrhagic death was more common in non-trauma vs. trauma patients (83 vs. 33%, P < 0.001). CONCLUSIONS: Non-traumatic hemorrhagic shock often resulted from a single bleeding site, and resulted in better 24-h survival than traumatic hemorrhage among Japanese patients who underwent REBOA. However, hospital mortality increased steadily in non-trauma patients affected by non-hemorrhagic causes after a longer period of critical care.
PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is now a feasible and less invasive resuscitation procedure. This study aimed to compare the clinical course of trauma and non-traumapatients undergoing REBOA. METHODS:Patient demographics, etiology, bleeding sites, hemodynamic response, length of critical care, and cause of death were recorded. Characteristics and outcomes were compared between non-trauma and traumapatients. Kaplan-Meier survival analysis was then conducted. RESULTS: Between August 2011 and December 2015, 142 (36 non-trauma; 106 trauma) cases were analyzed. Non-traumatic etiologies included gastrointestinal bleeding, obstetrics and gynecology-derived events, visceral aneurysm, abdominal aortic aneurysm, and post-abdominal surgery. The abdomen was a common bleeding site (69%), followed by the pelvis or extra-pelvic retroperitoneum. None of the non-traumapatients had multiple bleeding sites, whereas 45% of traumapatients did (P < 0.001). No non-traumapatients required resuscitative thoracotomy compared with 28% of the traumapatients (P < 0.001). Non-traumapatients presented a lower 24-h mortality than traumapatients (19 vs. 51%, P = 0.001). The non-trauma cases demonstrated a gradual but prolonged increased mortality, whereas survival in trauma cases rapidly declined (P = 0.009) with similar hospital mortality (68 vs. 64%). Non-traumapatients who survived for 24 h had 0 ventilator-free days and 0 ICU-free days vs. a median of 19 and 12, respectively, for traumapatients (P = 0.33 and 0.39, respectively). Non-hemorrhagic death was more common in non-trauma vs. traumapatients (83 vs. 33%, P < 0.001). CONCLUSIONS:Non-traumatic hemorrhagic shock often resulted from a single bleeding site, and resulted in better 24-h survival than traumatic hemorrhage among Japanese patients who underwent REBOA. However, hospital mortality increased steadily in non-traumapatients affected by non-hemorrhagic causes after a longer period of critical care.
Entities:
Keywords:
Critical care; Hemorrhagic shock; Non-trauma; Resuscitative endovascular occlusion of the aorta (REBOA); Trauma
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