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首页> 外文期刊>The journal of trauma and acute care surgery >Recent advances in austere combat surgery: Use of aortic balloon occlusion as well as blood challenges by special operations medical forces in recent combat operations
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Recent advances in austere combat surgery: Use of aortic balloon occlusion as well as blood challenges by special operations medical forces in recent combat operations

机译：Austere作战手术的最新进展：在最近作战行动中，使用特殊运营医疗力量的主动脉气球闭塞以及血液挑战

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of noncompressible torso hemorrhage is a technology that is increasingly being utilized in the combat casualty setting. Its use in the resource restricted environment holds potential to improve hemorrhage control, decrease blood product utilization, decrease morbidity, and improve combat mortality. The objective of this report is to present the single largest series of REBOA use on severely injured combat casualties.Over an 18-month period, austere surgical teams comprised of coalition partners provided initial damage control resuscitation (DCR) and surgical stabilization for over 2,300 combat casualties prior to transferring patients to the next level of trauma care. Twenty patients presented with injuries from explosion and gunshot wounds with mean initial heart rate of 129 bpm and mean initial systolic blood pressure of 71 mm Hg. Femoral cutdowns were used in six patients. Aortic occlusion was achieved with REBOA catheter placement in Zone 1 (n = 17) and Zone 3 (n = 2). Systolic blood pressure increased an average of 56 mm Hg with aortic occlusion. There were no access related site complications. All patients survived transport to the next level of care. The majority of blood products transfused in this cohort were whole blood, largely supported by emergent blood drives.This series demonstrates the potential for REBOA as a lifesaving technique for the patient who presents with hemodynamic instability and noncompressible torso hemorrhage. Resuscitative endovascular balloon occlusion of the aorta allows austere surgical teams to rapidly stabilize severely injured combat casualties, expand capability, and provide enhanced DCR while minimizing personnel, resources, and blood product utilization. The use of "whole blood only" strategy for DCR shows potential to be superior to traditional component therapy, and when combined with "proactive" REBOA utilization, provides significant improvements in hemodynamics and hemorrhage control.
机译：复苏血管内球囊闭塞的主动脉（Reboa）用于控制可逆躯干出血是一种技术，越来越多地用于战斗伤亡环境。其在资源受限制的环境中的使用具有改善出血控制的潜力，降低血液产品利用率，降低发病率，提高战斗死亡率。本报告的目的是提出对严重受伤战斗伤亡人员的最大系列雷博亚使用。一个18个月的时间，由联盟合作伙伴组成的AUSTERE手术团队提供了初始损害控制复苏（DCR）和2,300多个战斗的手术稳定将患者转移到新的创伤护理水平之前伤亡。二十例患者患有爆炸和枪伤伤害的伤害，平均初始心率为129bpm，平均初始收缩压为71毫米。六位患者使用股骨减排。在区域1（n = 17）和区域3（n = 2）中，通过REBOA导管置位实现主动脉闭塞。收缩压血压平均增加56毫米Hg，具有主动脉闭塞。没有访问相关的网站并发症。所有患者均存活运输到下一个护理水平。在这种队列中转移的大多数血液产物是全血，主要由紧急血液驱动器支持。该系列证明了Reboa作为患者患者的救生技术，患者呈现出血液动力学不稳定和不可抑制的躯干出血。复苏血管内气球闭塞的主动脉允许Austere手术团队迅速稳定严重受伤的战斗伤亡，扩大能力，并提供增强的DCR，同时最大限度地减少人员，资源和血液产品利用率。使用“全血”的DCR策略显示出优于传统组分治疗的潜力，并且当与“积极的”Reboa利用相结合，在血流动力学和出血控制中提供显着改善。

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