Importance Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a percutaneous transfemoral balloon technique used in select centers for resuscitation and temporary hemostasis, often instead of emergency department thoracotomy. The ability to perform aortic occlusion (AO) with an intravascular device allows focused occlusion at the most distal level to perfuse proximal regions while slowing hemorrhage to injured areas.

Objective To describe what is to date the largest single-institution experience with REBOA in the United States.

Design, Setting, and Participants Use of REBOA at an urban tertiary care facility for severe traumatic hemorrhage, traumatic arrest (AR), or nontraumatic hemorrhage (NTH) was investigated from February 1, 2013, to January 31, 2017, among 90 patients who were not responsive or were transiently responsive to resuscitation measures, or were in arrest, from presumed hemorrhage below the diaphragm. Possible causes were trauma or nontrauma-related hemorrhage. Patients with ruptured aortic aneurysms were excluded.

Main Outcomes and Measures In-hospital mortality.

Results Of the 90 patients in the study (15 women and 75 men; mean [SD] age, 41.5 [17.4] years), 29 underwent REBOA for severe traumatic hemorrhage, 50 for AR, and 11 for NTH. For the patients with severe traumatic hemorrhage and AR, the median age was 36.2 years (interquartile range, 25.3-55.5 years), mean (SD) admission Glasgow Coma Scale score was 6 (5), and median Injury Severity Score was 39 (interquartile range, 10-75). The distal thoracic aorta was occluded in 73 patients (81%), and in all patients with AR. A total of 17 patients (19%) had distal abdominal AO. Mean (SD) systolic blood pressure improved in patients with severe traumatic hemorrhage, from 68 (28) mm Hg prior to AO, to 131 (12) mm Hg after AO (P < .001). Percutaneous access was used in 30 patients (33%), including 13 patients with AR (26%), and groin cutdown in 60 patients (67%), including 37 patients with AR (74%). Overall 30-day mortality was 62% (n = 56): 11 (39%) in patients with severe traumatic hemorrhage and 45 (90%) in patients with AR. Of the patients with AR, 29 (58%) had return of spontaneous circulation and 11 of those patients (38%) survived to the operating room. All patients who survived AR gained full neurologic recovery. No aortoiliac injury or limb loss occurred from REBOA use. Eleven patients underwent REBOA for NTH; 7 (64%) were in arrest. Overall in-hospital mortality for patients with NTH was 36% (n = 4). No procedural complications occurred in this group.

Conclusions and Relevance REBOA is a minimally invasive alternative to emergency department thoracotomy with aortic cross-clamp to temporize noncompressible torso hemorrhage and obtain proximal control in both traumatic and nontraumatic causes of hemorrhage. REBOA can also be used for more targeted AO in the distal aorta for pelvic, junctional, or extremity hemorrhage.

重要性 复苏性主动脉血管内球囊阻塞（REBOA）是经皮的股动脉球囊技术，用于某些复苏和暂时性止血中心，通常代替急诊开胸手术。利用血管内装置执行主动脉闭塞（AO）的能力允许在最远侧进行集中闭塞以灌注近端区域，同时减慢受伤部位的出血。

目的 描述迄今为止美国最大的单机构REBOA经验。

2013年2月1日至2017年1月31日在90例患者中调查了REBOA在城市三级护理设施中用于严重外伤性出血，外伤性骤停（AR）或非创伤性出血（NTH）的设计，设置和参与者因the膜下出血而对复苏措施无反应或短暂反应，或被逮捕。可能的原因是外伤或非创伤性出血。主动脉瘤破裂的患者被排除在外。

主要结果和衡量 院内死亡率。

结果 在研究的90例患者中（15名女性和75名男性；平均[SD]年龄为41.5 [17.4]岁），其中29例因严重外伤性出血接受了REBOA治疗，AR者50例，NTH接受了11例。对于患有严重创伤性出血和AR的患者，中位年龄为36.2岁（四分位间距为25.3-55.5岁），平均（SD）入院格拉斯哥昏迷量表得分为6（5），中位伤害严重度得分为39（四分位）范围10-75）。73例患者（81％）以及所有AR患者均阻塞了胸主动脉远端。共有17例患者（19％）患有远端腹部AO。严重创伤性出血患者的平均（SD）收缩压有所改善，从AO前的68（28）mm Hg到AO后的131（12）mm Hg（P <.001）。经皮入路用于30例患者（33％），包括13例AR患者（26％），腹股沟切开术用于60例患者（67％），包括37例AR患者（74％）。30天总死亡率为62％（n = 56）：严重创伤性出血患者为11（39％），AR患者为45（90％）。在AR患者中，有29名（58％）恢复了自发性循环，其中11名患者（38％）存活到了手术室。所有在AR中幸存的患者均获得了完全的神经功能恢复。使用REBOA不会引起主动脉损伤或肢体脱落。11例患者接受NBO REBOA治疗；7（64％）被捕。NTH患者的总体住院死亡率为36％（n = 4）。该组无手术并发症发生。

结论与相关性 REBOA是急诊开胸与主动脉夹钳的一种微创替代方法，可暂时性压迫性躯干出血，并在创伤性和非创伤性出血原因中获得近端控制。REBOA还可以用于远端主动脉的骨盆，关节或四肢出血的靶向性AO。