RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA AND RESUSCITATIVE THORACOTOMY ARE ASSOCIATED WITH SIMILAR OUTCOMES IN TRAUMATIC CARDIAC ARREST
Document Type
Article
Publication Date
6-29-2023
Institution/Department
Surgery
Journal Title
The journal of trauma and acute care surgery
Abstract
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive alternative to resuscitative thoracotomy (RT) for patients with hemorrhagic shock. However, the potential benefits of this approach remain subject of debate. The aim of this study was to compare the outcomes of REBOA and RT for traumatic cardiac arrest. METHODS: A planned secondary analysis of the United States Department of Defense-funded Emergent Truncal Hemorrhage Control study was performed. Between 2017 and 2018, a prospective observational study of non-compressible torso hemorrhage was conducted at 6 Level 1 trauma centers. Patients were dichotomized by REBOA or RT, and baseline characteristics and outcomes were compared between groups. RESULTS: A total of 454 patients were enrolled in the primary study, of which 72 patients were included in the secondary analysis (26 underwent REBOA and 46 underwent resuscitative thoracotomy). REBOA patients were older, had a greater body mass index, and were less likely to be the victims of penetrating trauma. REBOA patients also had less severe abdominal injuries and more severe extremity injuries, though the overall injury severity scores were similar. There was no difference in mortality between groups (88% vs. 93%, p = 0.767). However, time to aortic occlusion was longer in REBOA patients (7 minutes vs. 4 minutes, p = 0.001) and they required more transfusions of red blood cells (4.5 units vs. 2.5 units, p = 0.007) and plasma (3 units vs. 1 unit, p = 0.032) in the emergency department. After adjusted analysis, mortality remained similar between groups (RR 0.89, 95% CI 0.71-1.12, p = 0.304). CONCLUSION: REBOA and RT were associated with similar survival after traumatic cardiac arrest, though time to successful AO was longer in the REBOA group. Further research is needed to better define the role of REBOA in trauma. LEVEL OF EVIDENCE: Therapeutic/care management; Level II.
Recommended Citation
Koh EY, Fox EE, Wade CE, et al. RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA AND RESUSCITATIVE THORACOTOMY ARE ASSOCIATED WITH SIMILAR OUTCOMES IN TRAUMATIC CARDIAC ARREST [published online ahead of print, 2023 Jun 29]. J Trauma Acute Care Surg. 2023;10.1097/TA.0000000000004094. doi:10.1097/TA.0000000000004094