Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales

Abstract

IntroductionNon-compressible torso haemorrhage (NCTH) carries a high mortality in trauma as many patients exsanguinate prior to definitive haemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct that has the potential to bridge patients to definitive haemostasis. However, the proportion of trauma patients in whom REBOA may be utilised is unknown.MethodsWe conducted a population based analysis of 2012–2013 Trauma Audit and Research Network (TARN) data. We identified the number of patients in whom REBOA may have been utilised, defined by an Abbreviated Injury Scale score ≥3 to abdominal solid organs, abdominal or pelvic vasculature, pelvic fracture with ring disruption or proximal traumatic lower limb amputation, together with a systolic blood pressure <90 mm Hg. Patients with non-compressible haemorrhage in the mediastinum, axilla, face or neck were excluded.ResultsDuring 2012–2013, 72 677 adult trauma patients admitted to hospitals in England and Wales were identified. 397 patients had an indication(s) and no contraindications for REBOA with evidence of haemorrhagic shock: 69% men, median age 43 years and median Injury Severity Score 32. Overall mortality was 32%. Major trauma centres (MTCs) received the highest concentration of potential REBOA patients, and would be anticipated to receive a patient in whom REBOA may be utilised every 95 days, increasing to every 46 days in the 10 MTCs with the highest attendance of this injury type.ConclusionsThis TARN database analysis has identified a small group of severely injured, resource intensive patients with a highly lethal injury that is theoretically amenable to REBOA. The highest density of these patients is seen at MTCs, and as such a planned evaluation of REBOA should be further considered in these hospitals.

How many patients could benefit from REBOA in prehospital care? A retrospective study of patients rescued by the doctors of the Paris fire brigade

“…Utilising the inclusion criteria proposed in this study, 3.2% of patients would have been eligible to undergo REBOA, similar to that reported by Barnard et al 4 (5.4%). Among the inclusion criteria proposed is the prior administration of high dose amine.…”

Resuscitative endovascular balloon occlusion of the aorta versus aortic cross clamping among patients with critical trauma: a nationwide cohort study in Japan

“…REBOA has recently found use as a general technique across major emergency centers in Japan. The highest density of potential REBOA patients is also seen at major trauma centers in England and Wales, although the number of patients in whom REBOA was utilized is small [9]. In fact, a review of the potential use of REBOA in exsanguinating hemorrhage cases in the US suggested that this new technique should be thoroughly evaluated for broad use, but the literature currently suffers from a dearth of human studies on REBOA [10].…”

“…Although we controlled for this in our study, the differences between REBOA and ACC in general need more context for accurate interpretation. In Japan, ACC currently seems to be a preferred intervention tactic in non-survivable injury cases and this differs from other countries, possibly making Japanese ACC-related mortality rates non-indicative of actual outcomes [1, 9, 13]. In addition, other patient characteristics such as better Glasgow Coma Scale (GCS) scores in cases where REBOA was used versus ACC cases (with more severe GCS scores) may also skew results.…”

Partial Zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in Management of Multiple Trauma with Combined Abdominal and Pelvic Injury

“…Partial inflation with controlled hypotensive target allowed benefits overcome risks of a defective procedure. REBOA adoption, even in a potentially dangerous position, gave authors time to move patient from OR to angiographic room (not available at the moment in our hospital a hybrid surgical angiographic suite) [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and time to find the primary source in a severe and multiple hemorrhagic trauma, with good clinical outcome.…”