Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma

Abstract

IMPORTANCE The need for improved methods of hemorrhage control and resuscitation has resulted in a reappraisal of resuscitative endovascular balloon occlusion of the aorta (REBOA). However, there is a paucity of data regarding the use of REBOA on a multi-institutional level in the United States. OBJECTIVE To evaluate the outcomes in trauma patients after REBOA placement. DESIGN, SETTING, AND PARTICIPANTS A case-control retrospective analysis was performed of the 2015-2016 American College of Surgeons Trauma Quality Improvement Program data set, a national multi-institutional database of trauma patients in the United States. A total of 593 818 adult trauma patients (aged Ն18 years) were analyzed and 420 patients were matched and included in the study; patients who were dead on arrival or were transferred from other facilities were excluded. Trauma patients who underwent REBOA placement in the ED were identified and matched with a similar cohort of patients (the no-REBOA group). Both groups were matched in a 1:2 ratio using propensity score matching for demographics, vital signs, mechanism of injury, injury severity score, head abbreviated injury scale score, each body region abbreviated injury scale score, pelvic fractures, lower extremity vascular injuries and fractures, and number and grades of intra-abdominal solid organ injuries. MAIN OUTCOMES AND MEASURES Outcome measures were the rates of complications and mortality. RESULTS Of 593 818 trauma patients, 420 patients (the REBOA group, 140 patients; 36 women and 104 men; mean [SD] age, 44 [20] years; the no-REBOA group, 280 patients; 77 women and 203 men; mean [SD] age, 43 [19] years) were matched and included in the analysis. Among the REBOA group, median injury severity score was 29 (interquartile range [IQR], 18-38) and 129 patients (92.1%) had a blunt mechanism of injury. There was no significant difference between groups in median 4-hour blood transfusion

Feasibility study for implementation of resuscitative balloon occlusion of the aorta in peri‐arrest, exsanguinating trauma at an adult level 1 Australian trauma centre

“…In a recent US national matched analysis, Joseph et al . reconfirmed the need to define the patient population for which REBOA has benefit . Lendrum et al .…”

REBOA – Resuscitative Endovascular Balloon Occlusion of the Aorta

“…Die aktuelle S3-Leitlinie Polytrauma/Schwerverletztenversorgung spricht dem Verfahren bei Patienten in extremis eine "Kann"-Empfehlung (GoR 0) aus und weist somit, wie auch die aktuellste Edition der "European Guideline on Management of Major Bleeding and Coagulopathy following Trauma", auf die Möglichkeit der temporären endovaskulären Ballonokklusion hin [1,2]. ▪ Ein genereller Überlebensvorteil durch die REBOA-Anwendung konnte in der Literatur bisher nicht gezeigt werden, und es existieren sowohl Untersuchungen mit positivem als auch mit negativem REBOA-Effekt [21,22].…”

REBOA: Where are we now?

“…However, a recent national analysis from the United States seemed to suggest harm from REBOA and although the paper certainly caused an appropriate pause in growing groundswell of pro‐REBOA opinion, the paper was far from being the high‐quality evidence required. This was pointed out in well‐publicised responses .…”