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    Intraoperative REBOA: An analysis of the American Association for the Surgery of Trauma AORTA registry

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    Author
    Vella, M.A.
    Dubose, J.
    Morrison, J.
    Date
    2019
    Journal
    Trauma Surgery and Acute Care Open
    Publisher
    BMJ Publishing Group
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1136/tsaco-2019-000340
    Abstract
    Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality. Methods The American Association for the Surgery of Trauma AORTA registry was used to identify patients undergoing REBOA. Injury characteristics and outcomes data were compared between OR and ED groups. The primary outcome was in-hospital mortality; secondary outcomes included total AO time, transfusion requirements, and acute kidney injury. Results Location and timing of catheter insertion were available for 305 of 321 (95%) subjects. 58 patients underwent REBOA in the OR (19%). There were no differences with respect to sex, admission lactate, and Injury Severity Score. The OR group was younger (33 years vs. 41 years, p=0.01) and with more penetrating injuries (36% vs. 15%, p<0.001). There were significant differences with respect to admission physiology. Time from admission to AO was longer in the OR group (75 minutes vs. 23 minutes, p<0.001) as was time to definitive hemostasis (116 minutes vs. 79 minutes, p=0.01). Unadjusted mortality was lower in the OR group (36.2% vs. 68.8%, p<0.001). There were no differences in secondary outcomes. After controlling for covariates, there was no association between insertion location and in-hospital mortality (OR 1.8, 95% CI 0.30 to 11.50). Discussion OR REBOA placement is common and generally employed in patients with more stable admission physiology. OR placement was not associated with increased in-hospital mortality despite longer times to AO and definite hemostasis when compared with catheters placed in the ED. Level of evidence IV; therapeutic/care management. Copyright Author(s)
    Keyword
    emergency department thoracotomy
    endovascular procedures
    hemorrhagic shock
    resuscitation for Shock
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85075300111&doi=10.1136%2ftsaco-2019-000340&partnerID=40&md5=5e32928e32bce5cb2ceb631b8745979d; http://hdl.handle.net/10713/11470
    ae974a485f413a2113503eed53cd6c53
    10.1136/tsaco-2019-000340
    Scopus Count
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    UMB Open Access Articles 2019

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