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

Fitzgerald, Mark; Lendrum, Robbie; Bernard, Stephen; Moloney, John; Smit, De Villiers; Mathew, Joseph; Kim, Yesul; Nickson, Christopher P; Lin, Richard M-H; Yeung, Meei; Bystrzycki, Adam; Niggemeyer, Louise E.; Hendel, Simon; Mitra, Biswadev

doi:10.1111/1742-6723.13443

Cited by 9 publications

(6 citation statements)

References 41 publications

(47 reference statements)

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“…A previous systematic review and meta-analysis regarding REBOA 4 reported mortality rates of up to 75.9%. This high mortality rate might foster skepticism among certain clinicians 19 . Studies using propensity score matching based on national databases, such as the National Trauma Data Bank and Japan Trauma Data Bank, have reported unfavorable outcomes 20 – 22 .…”

Section: Discussionmentioning

confidence: 99%

Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study

Yu,

Cho,

Kang

et al. 2024

Sci Rep

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Recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) had been introduced as an innovative procedure for severe hemorrhage in the abdomen or pelvis. We aimed to investigate risk factors associated with mortality after REBOA and construct a model for predicting mortality. This multicenter retrospective study collected data from 251 patients admitted at five regional trauma centers across South Korea from 2015 to 2022. The indications for REBOA included patients experiencing hypovolemic shock due to hemorrhage in the abdomen, pelvis, or lower extremities, and those who were non-responders (systolic blood pressure (SBP) < 90 mmHg) to initial fluid treatment. The primary and secondary outcomes were mortality due to exsanguination and overall mortality, respectively. After feature selection using the least absolute shrinkage and selection operator (LASSO) logistic regression model to minimize overfitting, a multivariate logistic regression (MLR) model and nomogram were constructed. In the MLR model using risk factors selected in the LASSO, five risk factors, including initial heart rate (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.98–1.00; p = 0.030), initial Glasgow coma scale (aOR, 0.86; 95% CI 0.80–0.93; p < 0.001), RBC transfusion within 4 h (unit, aOR, 1.12; 95% CI 1.07–1.17; p < 0.001), balloon occlusion type (reference: partial occlusion; total occlusion, aOR, 2.53; 95% CI 1.27–5.02; p = 0.008; partial + total occlusion, aOR, 2.04; 95% CI 0.71–5.86; p = 0.187), and post-REBOA systolic blood pressure (SBP) (aOR, 0.98; 95% CI 0.97–0.99; p < 0.001) were significantly associated with mortality due to exsanguination. The prediction model showed an area under curve, sensitivity, and specificity of 0.855, 73.2%, and 83.6%, respectively. Decision curve analysis showed that the predictive model had increased net benefits across a wide range of threshold probabilities. This study developed a novel intuitive nomogram for predicting mortality in patients undergoing REBOA. Our proposed model exhibited excellent performance and revealed that total occlusion was associated with poor outcomes, with post-REBOA SBP potentially being an effective surrogate measure.

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Section: Discussionmentioning

confidence: 99%

Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study

Yu,

Cho,

Kang

et al. 2024

Sci Rep

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“…Gut resuscitation with adenosine, lidocaine, and magnesium after REBOA is under preclinical study [35 ▪ ]. Given the circumstances in which it is used, high-quality prospective trials are difficult to conduct [36 ▪ ]. However, a recent 12-month prospective observational study of patients >15 years old with immediately life-threatening noncompressible truncal hemorrhage treated with REBOA at 6 USA Level 1 trauma centers reports the procedure as technically safe, with low procedural complication rates, and associated with successful return of spontaneous circulation in 59% of patients [37 ▪ ].…”

Section: Balloons and Hemostatic Dressingsmentioning

confidence: 99%

Advances in hemorrhage control resuscitation

Muldowney

Aichholz

Nathwani

et al. 2022

Current Opinion in Anaesthesiology

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Purpose of reviewDespite significant advances in trauma management over the last twenty years, uncontrolled hemorrhage remains the leading cause of preventable death in trauma. We review recent changes affecting hemorrhage control resuscitation.Recent findingsEarly blood product usage has become well established as a standard of care in trauma hemorrhage control. To enable this, low titer group A liquid plasma and group O whole blood are increasingly utilized. Single donor apheresis platelets have now replaced pooled donor platelets in the USA and are often pathogen reduced, which has implications for trauma resuscitation. Further work is examining timing and dosing of tranexamic acid and the debate in factor concentrate usage in trauma induced coagulopathy continues to evolve. The ‘Stop the bleed’ campaign has highlighted how important the use of hemostatic dressings are in hemorrhage control, as too is the expanded use of endovascular aortic occlusion. We highlight the ongoing research into desmopressin use and the undetermined significance of ionized calcium levels in trauma. Finally, we discuss our own hospital experience with coagulation testing and the paucity of evidence of improved outcomes with viscoelastic testing.SummaryImproving trauma coagulopathy diagnostics and hemorrhage control are vital if we are to decrease the mortality associated with trauma.

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“…In this edition, a group from The Alfred in Melbourne publish their experience with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) . The paper highlights the challenges with setting up clinical trials in critical care patients, especially for interventions that are ‘high acuity, high consequence, low frequency’.…”

Section: Competing Interestsmentioning

confidence: 99%

REBOA: Where are we now?

Ellis

2020

Emerg Medicine Australasia

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

Cited by 9 publications

References 41 publications

Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study

Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study

Advances in hemorrhage control resuscitation

REBOA: Where are we now?

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