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Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry

BACKGROUND: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) performed early after hospital admission in patients with TCA is...

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Autores principales: Hilbert-Carius, Peter, McGreevy, David T., Abu-Zidan, Fikri M., Hörer, Tal M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104487/
https://www.ncbi.nlm.nih.gov/pubmed/32228640
http://dx.doi.org/10.1186/s13017-020-00301-8
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author Hilbert-Carius, Peter
McGreevy, David T.
Abu-Zidan, Fikri M.
Hörer, Tal M.
author_facet Hilbert-Carius, Peter
McGreevy, David T.
Abu-Zidan, Fikri M.
Hörer, Tal M.
author_sort Hilbert-Carius, Peter
collection PubMed
description BACKGROUND: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. METHODS: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. RESULTS: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25–75). Fourteen patients (54%) had been admitted to the hospital with ongoing CPR. Nine patients (35%) died within the first 24 h, while seventeen patients (65%) survived post 24 h. The survival rate to hospital discharge was 27% (n = 7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p = 0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. The survival rate in the 16 patients responding to REBOA was 37.5% (n = 6). REBOA with a median (range) duration of 45 (8–70) minutes significantly increases blood pressure from the median (range) 56.5 (0–147) to 90 (0–200) mmHg. CONCLUSIONS: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated.
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spelling pubmed-71044872020-03-31 Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry Hilbert-Carius, Peter McGreevy, David T. Abu-Zidan, Fikri M. Hörer, Tal M. World J Emerg Surg Research Article BACKGROUND: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. METHODS: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. RESULTS: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25–75). Fourteen patients (54%) had been admitted to the hospital with ongoing CPR. Nine patients (35%) died within the first 24 h, while seventeen patients (65%) survived post 24 h. The survival rate to hospital discharge was 27% (n = 7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p = 0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. The survival rate in the 16 patients responding to REBOA was 37.5% (n = 6). REBOA with a median (range) duration of 45 (8–70) minutes significantly increases blood pressure from the median (range) 56.5 (0–147) to 90 (0–200) mmHg. CONCLUSIONS: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated. BioMed Central 2020-03-30 /pmc/articles/PMC7104487/ /pubmed/32228640 http://dx.doi.org/10.1186/s13017-020-00301-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Hilbert-Carius, Peter
McGreevy, David T.
Abu-Zidan, Fikri M.
Hörer, Tal M.
Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry
title Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry
title_full Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry
title_fullStr Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry
title_full_unstemmed Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry
title_short Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry
title_sort pre-hospital cpr and early reboa in trauma patients — results from the abotrauma registry
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104487/
https://www.ncbi.nlm.nih.gov/pubmed/32228640
http://dx.doi.org/10.1186/s13017-020-00301-8
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