Resuscitative endovascular balloon occlusion of the aorta associated with improved survival in hemorrhagic shock

Abstract

Background Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is controversial as a hemorrhage control adjunct due to lack of data with a suitable control group. We aimed to determine outcomes of trauma patients in shock undergoing REBOA versus no-REBOA. Methods This single-center, retrospective, matched cohort study analyzed patients ≥16 years in hemorrhagic shock without cardiac arrest (2000–2019). REBOA (R; 2015–2019) patients were propensity matched 2:1 to historic (H; 2000–2012) and contemporary (C; 2013–2019) groups. In-hospital mortality and 30-day survival were analyzed using chi-squared and log rank testing, respectively. Results A total of 102,481 patients were included (R = 57, C = 88,545, H = 13,879). Propensity scores were assigned using age, race, mechanism, lowest systolic blood pressure, lowest Glasgow Coma Score (GCS), and body region Abbreviated Injury Scale scores to generate matched groups (R = 57, C = 114, H = 114). In-hospital mortality was significantly lower in the REBOA group (19.3%) compared to the contemporary (35.1%; p = 0.024) and historic (44.7%; p = 0.001) groups. 30-day survival was significantly higher in the REBOA versus no-REBOA groups. Conclusion In a high-volume center where its use is part of a coordinated hemorrhage control strategy, REBOA is associated with improved survival in patients with noncompressible torso hemorrhage.

Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock

“…The current study is in line with other recent studies reporting a survival benefit of ED REBOA over ED RT in the US as well as in other countries . A recent meta-analysis observed a similar benefit.…”

“…The current study is in line with other recent studies reporting a survival benefit of ED REBOA over ED RT in the US as well as in other countries. [8][9][10]12,14,17,18,20,21 A recent meta-analysis 22 observed a similar benefit. These are in contrast with the US study by Joseph at al 11 and 2 studies using the Japan Trauma Data Bank, 9,23 which found REBOA to be associated with higher mortality.…”

“…Contemporary investigations on their comparative effectiveness and safety lack appropriate control groups or provide disparate results. Harfouche et al 8 found a survival benefit of REBOA in a singlecenter study matching patients requiring REBOA to non-REBOA. However, the study excluded patients who arrived in cardiac arrest, when AO can be lifesaving, and the non-REBOA group was not necessarily treated with RT.…”

The use of Resuscitative Endovascular Balloon Occlusion of the Aorta in a pregnant woman with a ruptured splenic aneurysm and haemorrhagic shock: A case report

“…With the development of advanced endovascular techniques, REBOA has emerged as a less invasive alternative to aortic cross‐clamping for resuscitation and temporary haemorrhagic control 2 . Contemporary studies also suggest that REBOA reduces mortality in trauma patients with sub‐diaphragmatic haemorrhagic shock, 3 and is associated with improved survival in trauma patients with non‐compressible torso haemorrhage treated in a high‐volume centre 4 . Still, the indications for REBOA remain poorly defined, and there is conflicting evidence regarding the safety and efficiency of the procedure 5 .…”

“… 2 Contemporary studies also suggest that REBOA reduces mortality in trauma patients with sub‐diaphragmatic haemorrhagic shock, 3 and is associated with improved survival in trauma patients with non‐compressible torso haemorrhage treated in a high‐volume centre. 4 Still, the indications for REBOA remain poorly defined, and there is conflicting evidence regarding the safety and efficiency of the procedure. 5 We present a case of splenic artery aneurism in a pregnant woman, where REBOA was introduced late and standard surgical procedures failed to prevail, but provided a vital bridge to definitive treatment.…”