Do we need pre-hospital resuscitative endovascular balloon occlusion of the aorta (REBOA) in the civilian helicopter emergency medical services (HEMS)?

被引:4
作者
Hilbert-Carius, Peter [1 ,2 ]
Schmalbach, Bjarne [3 ]
Wrigge, Hermann [1 ,4 ]
Schmidt, Merve [3 ]
Abu-Zidan, Fikri. M. M. [5 ]
Aschenbrenner, Ulf [3 ,6 ]
Streibert, Fridolin [1 ,2 ]
机构
[1] Bergmannstrost BG Hosp, Dept Anesthesiol Intens Care Emergency Med & Pain, Merseburgerstr 165, D-06179 Saale, Halle, Germany
[2] DRF Luftrettung German Air Rescue HEMS, Christoph 84 & 85, Halle, Saale, Germany
[3] DRF Luftrettung, Wissenschaftlicher Arbeitskreis Scient Working Grp, Filderstadt, Germany
[4] Martin Luther Univ Halle Wittenberg, Med Fac, Halle, Germany
[5] United Arab Emirates Univ, Coll Med & Hlth Sci, Stat & Res Methodol, Res Off, Al Ain, U Arab Emirates
[6] Christoph Dortmund, DRF Luftrettung German Air Rescue HEMS, Dortmund, Germany
关键词
Trauma; Non-compressible torso hemorrhage; REBOA; HEMS; Pre-hospital care; TRAUMA PATIENTS; GAP; OPTION; SKILLS; CARE;
D O I
10.1007/s11739-022-03158-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Pre-hospital resuscitative endovascular balloon occlusion of the aorta (REBOA) can be a life-saving procedure for patients with non-compressible torso hemorrhage. We aimed to evaluate the potential eligibility for REBOA in trauma patients of a civilian helicopter emergency medical service (HEMS) using a stepwise approach. A retrospective analysis using the electronic database (HEMSDER) of "DRF Luftrettung " HEMS covering the period from January 2015 to June 2021 was performed. Trauma patients aged & GE; 16 years and with a National Advisory Committee for Aeronautics (NACA) score of & GE; 4 were assessed for potential REBOA eligibility using two different decision trees based on assumed severe bleeding due to injuries of the abdomen, pelvis, and/or lower extremities and different vital signs on the scene and at hospital handover. Non-parametric statistical methods were used for comparison. A total of 22.426 patients met the inclusion criteria for data analysis. Of these, 0.15-2.24% were possible candidates for pre-hospital REBOA. No significant differences between groups on scene and at hospital handover regarding demographics, assumed injuries, and pre-hospital interventions were found. In the on-scene group, 21.1% of the patients remained unstable even at hospital handover despite pre-hospital care. In the handover group, 42.8% of the patients seemed initially stable but then deteriorated during the pre-hospital course. The number of potential pre-hospital REBOA in severely injured patients with a NACA score of & GE; 4 is < 3% or can be even < 1% if more strict criteria are used. There are some patients who may benefit from pre-hospital REBOA as a life-saving procedure. Further research on earlier diagnosis of life-threatening bleeding and proper indications of REBOA in trauma patients is needed.
引用
收藏
页码:627 / 637
页数:11
相关论文
共 34 条
[1]   Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales [J].
Barnard, Edward Benjamin Graham ;
Morrison, Jonathan James ;
Madureira, Ricardo Mondoni ;
Lendrum, Robbie ;
Fragoso-Iniguez, Marisol ;
Edwards, Antoinette ;
Lecky, Fiona ;
Bouamra, Omar ;
Lawrence, Thomas ;
Jansen, Jan Olaf .
EMERGENCY MEDICINE JOURNAL, 2015, 32 (12) :926-932
[2]   A needs assessment of resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest in Norway [J].
Brede, Jostein Rodseth ;
Kramer-Johansen, Jo ;
Rehn, Marius .
BMC EMERGENCY MEDICINE, 2020, 20 (01)
[3]   Basic endovascular skills for trauma course: Bridging the gap between endovascular techniques and the acute care surgeon [J].
Brenner, Megan ;
Hoehn, Melanie ;
Pasley, Jason ;
Dubose, Joseph ;
Stein, Deborah ;
Scalea, Thomas .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2014, 77 (02) :286-291
[4]   The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest [J].
Daley, James ;
Morrison, Jonathan James ;
Sather, John ;
Hile, Lisa .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2017, 35 (05) :731-736
[5]   Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environmenttechnical and methodological aspects [J].
de Schoutheete, J. C. ;
Fourneau, I. ;
Waroquier, F. ;
De Cupere, L. ;
O'Connor, M. ;
Van Cleynenbreugel, K. ;
Ceccaldi, J. C. ;
Nijs, S. .
WORLD JOURNAL OF EMERGENCY SURGERY, 2018, 13
[6]   Training and assessment of competence in resuscitative endovascular balloon occlusion of the aorta (REBOA) - a systematic review [J].
Engberg, Morten ;
Taudorf, Mikkel ;
Rasmussen, Niklas Kahr ;
Russell, Lene ;
Lonn, Lars ;
Konge, Lars .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2020, 51 (02) :147-156
[7]   The REBOA Dissipation Curve: Training Starts to Wane at 6 Months in the Absence of Clinical REBOA Cases [J].
Hatchimonji, Justin S. ;
Sikoutris, Jennifer ;
Smith, Brian P. ;
Vella, Michael A. ;
Dumas, Ryan P. ;
Qasim, Zaffer A. ;
Gallagher, John J. ;
Reilly, Patrick M. ;
Raza, Shariq S. ;
Cannon, Jeremy W. .
JOURNAL OF SURGICAL EDUCATION, 2020, 77 (06) :1598-1604
[8]   Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study [J].
Henry, Reynold ;
Matsushima, Kazuhide ;
Henry, Rachel N. ;
Wong, Victor ;
Warriner, Zachary ;
Strumwasser, Aaron ;
Foran, Christopher P. ;
Inaba, Kenji ;
Rasmussen, Todd E. ;
Demetriades, Demetrios .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2019, 229 (04) :383-+
[9]   Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey [J].
Hilbert-Carius, Peter ;
Struck, Manuel F. ;
Rudolph, Marcus ;
Knapp, Jurgen ;
Rognas, Leif ;
Adler, Jorn ;
Slagt, Cor ;
Jacobsen, Lars ;
Pich, Henryk ;
Christian, Michael D. ;
Dandrifosse, Didier ;
Abu-Zidan, Fikri M. .
SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE, 2021, 29 (01)
[10]   Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry [J].
Hilbert-Carius, Peter ;
McGreevy, David ;
Abu-Zidan, Fikri M. ;
Horer, Tal M. .
WORLD JOURNAL OF EMERGENCY SURGERY, 2020, 15 (01)