Causes Of Death In The Acute Phase Of Trauma And REBOA In The Treatment Of Non-compressible Torso Hemorrhage:Meta-analysis And Clinical Application

Part I Causes of death in the acute phase of trauma:a meta-analysisObjective:To systematic evaluation of common causes of deaths in the acute phase(prehospital and emergency department)in patients with neck,chest,and abdominal trauma.Methods:We systematically searched the China National Knowledge Infrastructure(CNKI),Wanfang database,Pubmed database,and Embase for all studies that provided data on deaths in patients with neck,chest,and abdominal trauma during the acute period from the time of database construction to 01/2021,supplemented by literature tracing and manual search.Two researchers severally screened the literature consistent with inclusion and exclusion criteria,extracted information and evaluated the quality of the literature,and applied the metaprop within the Meta package provided by Stata14 to conduct a single-arm study Meta-analysis.Results:Fifty-five pieces of literature were included,including 29 papers on neck trauma,16 papers on chest trauma,and 10 papers on abdominal trauma,with a total sample size of 4081 cases and 260 patients who died during the acute period.Metaanalysis results showed that the common causes of death during the acute period for each site of trauma were neck trauma(cervical spinal cord injury,cervical macrovascular injury,cervical respiratory injury,with mortality rates of 0.07,0.06,0.03),chest trauma(thoracic aortic injury,cardiac injury,0.36,0.03),abdominal trauma(hemorrhagic shock due to liver,spleen,and abdominal vascular injury,mortality rate 0.03,0.07,0.13);Funnel plot and further Egger test showed that cervical macrovascular injury,cervical spinal cord injury,cardiac injury,and liver injury included in the study were not subject to publication bias(P>0.05).There was publication bias(P<0.05)in the included studies for cervical respiratory injuries,whereas no publication bias test was performed for thoracic aortic injuries due to the small number of final included literature.Conclusion:The most common causes of death in the acute period include mainly neck trauma(cervical spinal cord injury,cervical macrovascular injury,cervical airway injury),chest trauma(thoracic aortic injury,cardiac injury),and abdominal trauma(hemorrhagic shock due to liver,spleen,and abdominal vascular injury).Traumatic hemorrhagic shock is a common cause of death in all sites,aggressive and appropriate prehospital damage control surgical intervention is an effective program to further improve the prognosis of trauma patients.Part Ⅱ Resuscitative endovascular balloon occlusion of the aorta in the treatment of non-compressible torso hemorrhage mortality:a meta-analysisObjective:To systematically evaluate the effect of resuscitative endovascular balloon occlusion of the aorta(REBOA)versus other resuscitation modalities on inhospital mortality in patients with the trauma associated with non-compressible torso hemorrhage(NCTH).Methods:We systematically searched Pubmed database,Embase database,Web of Science database,and Cochrane Library for all studies on REBOA for NCTH from the time of database construction to 01/2021,supplemented by literature tracing and manual search.Two investigators screened the literature strictly consistent with inclusion and exclusion criteria,extracted information and literature quality analysis,selected a fixed effects model,and applied the Meta program package provided by Stata 14 for Meta-analysis.Results:A total of 13 publications were included,including 7993 patients with NCTH.The included pieces of literature were of high quality,with a 7-9 stars rating on the NOS(The Newcastle-Ottawa Scale).The results of the meta-analysis showed that patients treated with REBOA had a considerably lower risk of death than those receiving different resuscitation modalities(RR 0.90.95%CI 0.86-0.94);Funnel plot and additional Egger tests showed no publication bias in any of the enclosed studies(P>0.05).Conclusion:REBOA is an effective treatment for NCTH,improving the prognosis of trauma patients and reducing hospital-related mortality.At the same time,it is our future research direction to extend REBOA forward to the pre-hospital setting as a life-saving technique for damage control.PartⅢ REBOA for traumatic hemorrhagic shock:three cases reportHemorrhagic shock is one of the main causes of death during the acute period of trauma,accounting for 50%of preventable trauma deaths.In China,early anti-shock treatment is performed by restrictive fluid resuscitation,external compression hemostasis,etc.REBOA is the foreign standard resuscitation procedure for traumatic hemorrhagic shock,which can directly block the aorta at the proximal end of the bleeding site to ensure the perfusion of the brain and heart,and reduce the bleeding at the distal end.At present,there are few studies on this technique in China.This paper reports three clinical cases of REBOA applied in our department for the treatment of traumatic hemorrhagic shock and summarizes the relevant rescue experience.We know that early application of REBOA treatment could help circulation stability and creates opportunities for subsequent surgical treatment.