Association of resuscitative endovascular balloon occlusion of the aorta (REBOA) and mortality in penetrating trauma patients

García, Alberto; Manzano-Núñez, Ramiro; Orlas, Claudia; Ruiz-Yucuma, Juan; Londoño, Alejandra; Salazar, Camilo; Meléndez, Juan J.; Sánchez, Á.; Puyana, Juan Carlos; Ordóñez, Carlos A.

doi:10.1007/s00068-020-01370-9

Cited by 23 publications

(35 citation statements)

References 22 publications

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“…Of note, however, these guidelines often lack the representation of physicians from LMICs in their list of authors, and only a few studies performed in LMICs are included in the references supporting the guidelines. These disparities raise concerns that the challenges and problems on trauma care and REBOA implementation inherent to LMICs could be inadequately addressed [4,10]. Moreover, the lack of inclusion of stakeholders from LMICs into REBOA clinical guidelines may be of greater concern because most of the world's population lives in LMICs, where the burden of traumatic injuries is enormous, and outcomes are often poor [22].…”

Section: Discussionmentioning

confidence: 99%

“…Its use, as a tool within the broad concept of endovascular resuscitation and trauma management [2], has expanded worldwide [3][4][5], and data on trauma patients treated with REBOA from different countries in the world have been collected in different registries [6,7]. Furthermore, the field of endovascular hemorrhage control has experienced significant growth in the past years, and literature has emerged that offers contradictory findings of its safety and effectiveness [1,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…20 Several additional retrospective trials have shown improvement in mortality with REBOA with low complication rates. 6,46,47 Other large retrospective trials have shown poorer outcomes with REBOA. In 2019 Bellal et al published a large, multicentered, retrospective analysis of case-matched outcomes involving REBOA in traumatically injured patients.…”

Section: Challenges and Unknownsmentioning

confidence: 99%

“…Aortic occlusion was obtained in an average of 6.6 minutes, there was a low complication rate (2.2% pseudoaneurysm and 4.3% distal embolism), and REBOA had a similar survival rate to more invasive surgical techniques 20 . Several additional retrospective trials have shown improvement in mortality with REBOA with low complication rates 6,46,47 …”

Section: Challenges and Unknownsmentioning

confidence: 99%

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non‐traumatic cardiac arrest: A review

et al. 2020

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been proposed as a novel approach to managing non‐traumatic cardiac arrest (NTCA). During cardiac arrest, cardiac output ceases and perfusion of vital organs is compromised. Traditional advanced cardiac life support (ACLS) measures and cardiopulmonary resuscitation are often unable to achieve return of spontaneous circulation (ROSC). During insertion of REBOA a balloon‐tipped catheter is placed into the femoral artery and advanced in a retrograde manner into the aorta while the patient is undergoing cardiopulmonary resuscitation (CPR). The balloon is then inflated to fully occlude the aorta. The literature surrounding the use of aortic occlusion in non‐traumatic cardiac arrest is limited to animal studies, case reports and one recent non‐controlled feasibility trial. In both human and animal studies, preliminary data show that REBOA may improve coronary and cerebral perfusion pressures and key physiologic parameters during cardiac arrest resuscitation, and animal data have demonstrated improved rates of ROSC. Multiple questions remain before REBOA can be considered as an adjunct to ACLS. If demonstrated to be effective clinically, REBOA represents a potentially cost‐effective and generalizable intervention that may improve quality of life for patients with non‐traumatic cardiac arrest.

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“…This exciting approach is being defined and refined, very appropriately, in civilian trauma centers in Colombia, long known for having a very high prevalence of penetrating trauma. 13,14 . In recent years they have developed a truly multidisciplinary team of surgeons, medical and surgical intensivists, interventional radiologists and other ancillary personnel.…”

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confidence: 99%

Damage control surgery: a constant evolution

2020

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The story of trauma resuscitation is similar to that of many other advances in medicine: described, forgotten, reinvented, ridiculed, and finally accepted. Even after acceptance, the concepts go through periods of neglect and indifference before they are tried and enhanced, till the next advance. Damage control, a strategy for management of critically injured or ill patients, is a prime example of this phenomenon. It reminds us of the famous words of Oliver Goldsmith in 1761: “for he who fights and runs away, will live to fight another day, but he who is in battle slain, will never rise and fight again”. Damage control was based on the recognition of the lethal triad of hypothermia, acidosis, and a coagulopathy resulting from massive blood loss, large-volume resuscitation and ischemia-reperfusion. It was an approach that J. Hogarth Pringle from Glasgow, Scotland, suggested in 1908 with his principles of compression and hepatic packing for control of venous hemorrhage from the injured liver: temporary, expeditious and effective. Packing, however, was rarely utilized during World War II and the Vietnam War because of the presumed risk of rebleeding with removal of the packs. The ever-difficult challenge of “non-surgical bleeding” from a coagulopathy due to massive hepatic injuries did, eventually, lead to a resurrection of the concept of perihepatic packing in the 1980s in civilian centers and became one of the initial steps in damage control for patients with severe and/or multiple intra-abdominal injuries.

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Association of resuscitative endovascular balloon occlusion of the aorta (REBOA) and mortality in penetrating trauma patients

Cited by 23 publications

References 22 publications

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

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

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non‐traumatic cardiac arrest: A review

Damage control surgery: a constant evolution

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