Outcomes of abdominal trauma patients with hemorrhagic shock requiring emergency laparotomy: efficacy of intra‐aortic balloon occlusion

Abstract

Aim The aims of this study were to investigate outcomes of abdominal trauma in patients with hemorrhagic shock requiring emergency laparotomy and clarify the beneficial effects of intra‐aortic balloon occlusion (IABO) for intra‐abdominal hemorrhage in patients with critically uncontrollable hemorrhagic shock (CUHS). Methods We reviewed 44 hemorrhagic shock patients who underwent emergency laparotomy for intra‐abdominal hemorrhage over a 6‐year period. Of these patients, we examined data for 19 subjects who underwent IABO during initial resuscitation to control massive intra‐abdominal bleeding leading to CUHS. Results The average Injury Severity Score and probability of survival (Ps) of the 44 patients were 27.6 ± 15.4 and 0.735 ± 0.304, respectively, and the overall survival rate was 77.3%. The differences in the Glasgow Coma Scale, lactate level, prothrombin time – international normalized ratio, and Ps between the two groups (21 responders and 23 non‐responders) were statistically significant (P < 0.05). Intra‐aortic balloon occlusion was attempted in 19 of 23 patients (82.6%) with CUHS, and there were no statistically significant differences in presenting Glasgow Coma Scale, body temperature, lactate, prothrombin time – international normalized ratio, or Revised Trauma Score between the survivors (n = 12) and non‐survivors (n = 7). The only significant differences between these two groups were observed in Injury Severity Score (P = 0.047) and Ps (P = 0.007). In all patients, the balloons were successfully placed in 8.1 ± 3.3 min in the thoracic aorta, and a significant increase in systolic blood pressure was observed immediately after IABO. Conclusion The IABO procedure can be life‐saving in the management of patients with CUHS arising from intra‐abdominal hemorrhage, permitting transport to surgery.

Keywords

• Critically uncontrollable hemorrhagic shock
• intra‐abdominal hemorrhage
• intra‐aortic balloon occlusion
• trauma