Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry

Coccolini, Federico; Ceresoli, Marco; McGreevy, David; Sadeghi, Mitra; Pirouzram, Artai; Toivola, Asko; Skoog, Per; Idoguchi, Koji; Kon, Yuri; Ishida, Toshiro; Matsumura, Yosuke; Matsumoto, Junichi; Reva, Viktor; Maszkowski, Mariusz; Fugazzola, Paola; Tomasoni, Matteo; Cicuttin, Enrico; Ansaloni, Luca; Zaghi, Claudia; Sibilla, Maria Grazia; Cremonini, Camilla; Bersztel, Adam; Caragounis, Eva-Corina; Falkenberg, Mårten; Handolin, Lauri; Oosthuizen, George; Szarka, Endre; Manchev, V; Wannatoop, Tongporn; Chang, Sung Wook; Kessel, Boris; Hebron, Dan; Shaked, Gad; Bala, Miklosh; Ordóñez, Carlos A.; Hibert-Carius, Peter; Chiarugi, Massimo; Nilsson, Kristofer F.; Larzon, Thomas; Gamberini, Emiliano; Agnoletti, Vanni; Catena, Fausto; Hörer, Tal M.

doi:10.1007/s13304-020-00735-4

Cited by 23 publications

(23 citation statements)

References 10 publications

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“…Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage (NCTH) from exsanguination. It is used as a bridge to surgical bleeding control to gain time during the management of hemorrhagic shock as part of the endovascular resuscitation and trauma management (EVTM) concept [ 1 – 7 ]. Access to the common femoral artery (CFA) is essential for performing REBOA and is regularly gained by different medical specialists including vascular surgeons, interventional radiologists, anesthetists, and emergency physicians [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

et al. 2020

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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about “Who is and who should be performing it?” Methods Data from the international ABO (aortic balloon occlusion) Trauma Registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how, and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients. Results During the study period, 259 patients had been recorded in the registry, 72.5% (n = 188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5%, and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common femoral artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cutdown in 57 patients (24%), using ultrasound in 49 patients (21%), and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient’s age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room, and mortality. Conclusion A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cutdown is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing “Who should be performing REBOA?” future research should focus on “Which patient benefits most from REBOA?”

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Section: Introductionmentioning

confidence: 99%

Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

et al. 2020

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“…Zone 3 REBOA can be optimal, especially for pelvic bleeding, because it can raise blood pressure and reduce arterial bleeding associated with pelvic injury while preventing ischemic insult on visceral organs on top of having a long occlusion time. (30) Although there is little evidence of mortality bene t in previous articles, the WSES guidelines suggest REBOA as an alternative to ACC and that Zone 3 REBOA should be considered to be a bridge to de nitive treatment in hemodynamically unstable patients. (18) Our center has implemented REBOA in the pelvic injury management algorithm since 2016, and REBOA was performed in 10 patients; 80% of these were deployed in Zone 3 with 3 patients surviving and getting discharged.…”

Section: Discussionmentioning

confidence: 99%

Improvement of Outcomes in Hemodynamically Unstable Patients With Pelvic Fracture Following The Establishment of a Trauma Center: A Single Center Observational Study in Korea

Lee¹,

Yu²,

Lee³

et al. 2021

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Background: The trauma center and multidisciplinary management protocols have been proved to improve the outcomes of severely injured patients. Hemorrhage from pelvic injury is associated with high mortality and is a common cause of preventable trauma death. This study aims to evaluate the effects of the establishment of a trauma center and management protocols on the outcomes of hemodynamically unstable patients with pelvic fractures.Methods: Hemodynamically unstable patients with pelvic fractures were reviewed retrospectively over a 10-year period. They were grouped into periods 1 and 2, which were defined as before and after the establishment of a trauma center and protocols, respectively. Basic characteristics and outcomes were compared between periods.Results: This study enrolled a total of 106 patients. Basic and physiological characteristics were not significantly different in both periods. Pre-peritoneal packing (PPP) and resuscitative endovascular balloon occlusion of aorta (REBOA) were only performed in period 2 (PPP, N = 27; REBOA, N = 10). In period 2, the time from emergency room arrival to hemostatic intervention was significantly shorter (269 ± 132.4 min. vs. 147.2 ± 95.5 min., p < 0.0001), and mortality due to acute hemorrhage was significantly decreased (33.3% vs. 8.6%, p = 0.018). The multivariate logistic regression analysis identified age, ISS, and period 1 as independent risk factors for mortality.Conclusion: The establishment of a trauma center and multidisciplinary management protocols, such as PPP and REBOA, improved the outcomes of hemodynamically unstable patients with pelvic fractures.

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“…These registries were launched to collect patient and outcome data from trauma patients treated with REBOA. Details of each registry (AORTA, ABOTrauma) have been outlined in previous publications [6,7,11,12].…”

Section: Data Sourcementioning

confidence: 99%

Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

Manzano-Núñez

McGreevy²,

Orlas

et al. 2020

World J Emerg Surg

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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries’ income based on the World Bank Country and Lending Groups. Methods We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36‑1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63‑3,33; p = 0.3). Conclusion There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.

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Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry

Cited by 23 publications

References 10 publications

Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

Improvement of Outcomes in Hemodynamically Unstable Patients With Pelvic Fracture Following The Establishment of a Trauma Center: A Single Center Observational Study in Korea

Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

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