Validation of a Novel Clinical Criteria to Predict Candidacy for Aortic Occlusion: An Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Study

Abstract

For trauma patients with noncompressible truncal hemorrhage (NCTH), aortic occlusion (AO) is attempted with either resuscitative thoracotomy (RT) or the resuscitative endovascular balloon occlusion of the aorta (REBOA). However, it is often challenging to identify the group of patients who would benefit from AO procedures. We hypothesized that patients who met simple clinical criteria would have better outcomes following AO procedures. This is a retrospective cohort study using the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database (November 2013-August 2019) which included patients who arrived with signs of life and underwent AO procedures (RT or zone 1 REBOA). Outcomes were compared between patients who met the criteria (admission vital signs: Glasgow Coma Scale (GCS) ≥9 and systolic blood pressure <90 mm Hg) and those who did not. Subgroup analyses were then conducted on patients who had a REBOA placed and those who underwent RT. A total of 998 patients met our inclusion criteria. Of those, a REBOA was placed in 364 patients (37%), while 634 (64%) underwent RT. The overall mortality rate in the criteria (+) group was significantly lower than that in the criteria (−) group (62 vs. 79%, P < .001). In patients who survived beyond the emergency department following AO procedures, those who met the criteria underwent hemorrhage control procedures more frequently (83% vs. 57%, P < .001). Our data suggest that simple clinical criteria could guide the provider for proceeding with AO in patients with suspected NCTH.

A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum

“…Reserving REBOA only for very severe PAS cases, selected with presurgical evaluation of the invasion topography and intraoperative staging (parametrial involvement and viability of safe vesicouterine dissection), is a valid strategy when carried out by experienced groups who have additional technical resources to identify these patients and control unexpected intraoperative bleeding 8,12 . Our observation coincides with experiences in trauma patients, in which the appropriate REBOA candidates selection defines the effectiveness of the technique and the complications frequency 28 . Our experience reflects the benefits of interdisciplinary work and the application of learnings on trauma field, to the obstetric population.…”

“…8,12 Our observation coincides with experiences in trauma patients, in which the appropriate REBOA candidates selection defines the effectiveness of the technique and the complications frequency. 28 Our experience reflects the benefits of interdisciplinary work and the application of learnings on trauma field, to the obstetric population.…”

Systematic review to evaluate algorithms for REBOA use in trauma and identify a consensus for patient selection

“…Future directions may also include investigating the utility of incorporating Glasgow Coma Scale (GCS) score into REBOA patient selection decision-making, as a recent Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry study reported that GCS score ≥9 and SBP <90 were useful predictors of success of aortic occlusion. 23 Alternatively, in the context of a poor GCS score due to penetrating TBI, REBOA may be used as a less invasive means of aortic occlusion for the purpose of defining survivability for organ donation.…”

Consensus on resuscitative endovascular balloon occlusion of the aorta in civilian (prehospital) trauma care: A Delphi study

“…The criteria for REBOA decision making, timing, and identification of those who could benefit, whether prehospital or in-hospital, remain disputed. 15,[34][35][36] To give guidance to a widely supported protocol, we tried to narrow indications by combining trauma mechanism, physiological thresholds, response to fluid therapy and estimated transportation times. Earlier, SBP thresholds of 60 mm Hg to 70 mm Hg in penetrating and blunt trauma patients have been proposed as cutoff for aortic occlusion.…”