Effect of resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with multiple severe torso trauma: a retrospective study

Abstract

BackgroundAlthough resuscitative endovascular balloon occlusion of the aorta (REBOA) may be effective in trauma management, its effect in patients with severe multiple torso trauma remains unclear.MethodsWe performed a retrospective study to evaluate trauma management with REBOA in hemodynamically unstable patients with severe multiple trauma. Of 5899 severe trauma patients admitted to our hospital between January 2011 and January 2018, we selected 107 patients with severe torso trauma (Injury Severity Score > 16) who displayed persistent hypotension [≥ 2 systolic blood pressure (SBP) values ≤ 90 mmHg] regardless of primary resuscitation. Patients were divided into two groups: trauma management with REBOA (n = 15) and without REBOA (n = 92). The primary endpoint was the effectiveness of trauma management with REBOA with respect to in-hospital mortality. Secondary endpoints included time from arrival to the start of hemostasis. Multivariable logistic regression analysis, adjusted for clinically important variables, was performed to evaluate clinical outcomes.ResultsTrauma management with REBOA was significantly associated with decreased mortality (adjusted odds ratio of survival, 7.430; 95% confidence interval, 1.081–51.062; p = 0.041). The median time (interquartile range) from admission to initiation of hemostasis was not significantly different between the two groups [with REBOA 53.0 (40.0–80.3) min vs. without REBOA 57.0 (35.0–100.0) min ]. The time from arrival to the start of balloon occlusion was 55.7 ± 34.2 min. SBP before insertion of REBOA was 48.2 ± 10.5 mmHg. Total balloon occlusion time was 32.5 ± 18.2 min.ConclusionsThe use of REBOA without a delay in initiating resuscitative hemostasis may improve the outcomes in patients with multiple severe torso trauma. However, optimal use may be essential for success.

Resuscitative Endovascular Balloon Occlusion of the Aorta: Review of the Literature and Applications to Veterinary Emergency and Critical Care

“…Complete REBOA is nonetheless associated with a significant ischemic burden caudal to the balloon. Current REBOA guidelines recommend a maximum complete occlusion time of 30–45 min in zone 1, consistent with observations from retrospective studies (8). Longer occlusion times often result in serious ischemic injuries (24).…”

“…Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular hemorrhage control intervention that was first described in the Korean war (1). REBOA has recently re-gained popularity as an alternative to resuscitative thoracotomy (RT, thoracotomy and aortic cross-clamping) in trauma patients (2–8). RT has been associated with low survival rates (9, 10) and presents significant risks of injuries for care providers themselves.…”

Transcatheter arterial embolization of severe blunt liver injury in hemodynamically unstable patients: a retrospective 15-year study

“…One is the resuscitative endovascular balloon occlusion of the aorta (REBOA), which has been reported to improve prognosis in severe trauma refractory to initial infusion therapy. 26 Thus, the inclusion of REBOA in our strategy may have further improved the prognosis in the TAE group. The other option to effectively utilize TAE is the hybrid ER, where all examinations and treatments for trauma are carried out in a single station composed of a carbon-ber uoroscopic table with a self-propelled C-arm combined with a sliding gantry CT scanner.…”

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study

“…Usually, total occlusion is known to have a higher ischemic burden than partial occlusion [18]. The current guideline for REBOA recommends that total occlusion time in Zone 1 does not exceed 30-45 minutes [19]. However, there were three patients with ischemic complications in this study who received partial or intermittent occlusive REBOA, two of which were in Zone 3 and the other was in Zone 1.…”