Pre-hospital CPR and early REBOA in trauma patients - Results from the ABOTrauma Registry.

Abstract

Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to hospital with ongoing CPR. Nine patients (35%) died within the first 24 hours, while seventeen patients (65%) survived post 24 hours. The survival rate to hospital discharge was 27% (n=7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p=0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. Survival rate in the 16 patients responding to REBOA was 37.5% (n=6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from median (range) 56.5 (0-147) to 90 (0-200) mmHg. Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated. Keywords: REBOA, Cardiac Arrest, Trauma, CPR, Endovascular Resuscitation.

A Western Trauma Association critical decisions algorithm: Resuscitative endovascular balloon occlusion of the aorta

“…While a survival advantage for REBOA was seen in hypotensive patients who did not arrest, in those who did, regardless of when CPR was initiated, there was no benefit seen. Data from the ABOTrauma registry were used to examine the outcomes associated with REBOA in those who were in traumatic cardiac arrest 30 . In this case series of patients undergoing prehospital CPR, the observed mortality of 19 of the 26 arresting patients was seen to be better than the expected mortality according to Revised Injury Severity Calculation II, with the conclusion being that the use of REBOA in this clinical circumstance warrants further investigation.…”

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

“…23,24 Blind placement technique using anatomic landmarks and estimated distance has been developed for the use of REBOA in trauma patients. 25,26 This blind technique is likely adequate for use during NTCA and is currently in use in a Phase 1 clinical trial at Yale University. 27 Once in the desired position the balloon at the tip of the REBOA catheter is inflated with a radiopaque solution, fully occluding the aorta.…”

Successfully REBOA Performance: Does Medical Specialty Matter? International Data From the ABOTrauma Registry.

“…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)(2)(3)(4)(5)(6)(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).…”

“…With the present study we aimed to describe by who, how (regarding the access) and where REBOA is successfully being performed, using data from the unique international ABO (Aortic Balloon Occlusion) Trauma registry. We believe that this is highly relevant since the indications for the use of REBOA are also starting to include non-traumatic causes of hemodynamic instability or even cardiopulmonary resuscitation (CPR) (2,17).…”