IMPACT of TIME to EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION after NONCOMPRESSIBLE TORSO HEMORRHAGE

Jacob M. Broome; Ayman Ali; John T. Simpson; Sherman Tran; Danielle Tatum; Sharven Taghavi; Joseph Dubose; Juan Duchesne; Thomas M. Scalea; Rishi Kundi; William Teeter; Anna Romagnoli; Laura J. Moore; Kenji Inaba; Alice Piccinini; David S. Kauvar; Valorie L. Baggenstoss; Catherine Rauschendorfer; Jeremy Cannon; Mark Seamon; M. Chance Spalding; Timothy W. Wolff; Ernest Moore; Angela Sauia; David Turay; Xian Luo-Owen; David Skarupa; Jennifer A. Mull; Yohan Diaz Zuniga; Joseph Ibrahim; Karen Safcsak; Matthew Yanoff; Andrew W. Kirkpatrick; Chad G. Ball; Zhengwen Xiao; Elizabeth Dauer; Jennifer Knight; Nicole Cornell; Forrest Moore; Matthew Bloom; Nam T. Tran; Eileen Bulger; Jeannette G. Ward; John K. Bini; John Matsuura; Joshua Pringle; Karen Herzing; Kailey Nolan; Nathaniel Poulin; Rachel Nygaard; Chad Richardson; Derek Lumbard; Reagan Bollig; Brian Daley; Niki Rasnake; Marko Bukur; Elizabeth Warnack; Joseph Farhat; Robert M. Madayag; Greg Pinson; Dafney Davare; Seong Lee; Rachele Solomon; James Haan; Kelly Lightwine; Kristin Colling; Megan Brenner; Raul Coimbra; Sho Furata

doi:10.1097/SHK.0000000000001988

IMPACT of TIME to EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION after NONCOMPRESSIBLE TORSO HEMORRHAGE

Jacob M. Broome^*, Ayman Ali, John T. Simpson, Sherman Tran, Danielle Tatum, Sharven Taghavi, Joseph Dubose, Juan Duchesne, Thomas M. Scalea, Rishi Kundi, William Teeter, Anna Romagnoli, Laura J. Moore, Kenji Inaba, Alice Piccinini, David S. Kauvar, Valorie L. Baggenstoss, Catherine Rauschendorfer, Jeremy Cannon, Mark SeamonM. Chance Spalding, Timothy W. Wolff, Ernest Moore, Angela Sauia, David Turay, Xian Luo-Owen, David Skarupa, Jennifer A. Mull, Yohan Diaz Zuniga, Joseph Ibrahim, Karen Safcsak, Matthew Yanoff, Andrew W. Kirkpatrick, Chad G. Ball, Zhengwen Xiao, Elizabeth Dauer, Jennifer Knight, Nicole Cornell, Forrest Moore, Matthew Bloom, Nam T. Tran, Eileen Bulger, Jeannette G. Ward, John K. Bini, John Matsuura, Joshua Pringle, Karen Herzing, Kailey Nolan, Nathaniel Poulin, Rachel Nygaard, Chad Richardson, Derek Lumbard, Reagan Bollig, Brian Daley, Niki Rasnake, Marko Bukur, Elizabeth Warnack, Joseph Farhat, Robert M. Madayag, Greg Pinson, Dafney Davare, Seong Lee, Rachele Solomon, James Haan, Kelly Lightwine, Kristin Colling, Megan Brenner, Raul Coimbra, Sho Furata

^*Corresponding author for this work

Surgery

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Abstract

Introduction: Time is an essential element in outcomes of trauma patients. The relationship of time to treatment in management of noncompressible torso hemorrhage (NCTH) with resuscitative endovascular balloon occlusion of the aorta (REBOA) or resuscitative thoracotomy (RT) has not been previously described. We hypothesized that shorter times to intervention would reduce mortality. Methods: A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry from 2013 to 2022 was performed to identify patients who underwent emergency department aortic occlusion (AO). Multivariate logistic regression was used to examine the impact of time to treatment on mortality. Results: A total of 1,853 patients (1,245 [67%] RT, 608 [33%] REBOA) were included. Most patients were male (82%) with a median age of 34 years (interquartile range, 30). Median time from injury to admission and admission to successful AO were 31 versus 11 minutes, respectively. Patients who died had shorter median times from injury to successful AO (44 vs. 72 minutes, P < 0.001) and admission to successful AO (10 vs. 22 minutes, P < 0.001). Multivariate logistic regression demonstrated that receiving RT was the strongest predictor of mortality (odds ratio [OR], 6.6; 95% confidence interval [CI], 4.4-9.9; P < 0.001). Time from injury to admission and admission to successful AO were not significant. This finding was consistent in subgroup analysis of RT-only and REBOA-only populations. Conclusions: Despite expedited interventions, time to aortic occlusion did not significantly impact mortality. This may suggest that rapid in-hospital intervention was often insufficient to compensate for severe exsanguination and hypovolemia that had already occurred before emergency department presentation. Selective prehospital advanced resuscitative care closer to the point of injury with "scoop and control"efforts including hemostatic resuscitation warrants special consideration.

Original language	English
Pages (from-to)	275-279
Number of pages	5
Journal	Shock
Volume	58
Issue number	4
DOIs	https://doi.org/10.1097/SHK.0000000000001988
State	Published - 1 Oct 2022

Keywords

Hemorrhagic shock
aortic occlusion
mortality
resuscitative endovascular balloon occlusion of the aorta
resuscitative thoracotomy

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10.1097/SHK.0000000000001988

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Broome, J. M., Ali, A., Simpson, J. T., Tran, S., Tatum, D., Taghavi, S., Dubose, J., Duchesne, J., Scalea, T. M., Kundi, R., Teeter, W., Romagnoli, A., Moore, L. J., Inaba, K., Piccinini, A., Kauvar, D. S., Baggenstoss, V. L., Rauschendorfer, C., Cannon, J., ... Furata, S. (2022). IMPACT of TIME to EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION after NONCOMPRESSIBLE TORSO HEMORRHAGE. Shock, 58(4), 275-279. https://doi.org/10.1097/SHK.0000000000001988

@article{afe50e53a69a42cd9bc300305a89048f,

title = "IMPACT of TIME to EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION after NONCOMPRESSIBLE TORSO HEMORRHAGE",

abstract = "Introduction: Time is an essential element in outcomes of trauma patients. The relationship of time to treatment in management of noncompressible torso hemorrhage (NCTH) with resuscitative endovascular balloon occlusion of the aorta (REBOA) or resuscitative thoracotomy (RT) has not been previously described. We hypothesized that shorter times to intervention would reduce mortality. Methods: A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry from 2013 to 2022 was performed to identify patients who underwent emergency department aortic occlusion (AO). Multivariate logistic regression was used to examine the impact of time to treatment on mortality. Results: A total of 1,853 patients (1,245 [67%] RT, 608 [33%] REBOA) were included. Most patients were male (82%) with a median age of 34 years (interquartile range, 30). Median time from injury to admission and admission to successful AO were 31 versus 11 minutes, respectively. Patients who died had shorter median times from injury to successful AO (44 vs. 72 minutes, P < 0.001) and admission to successful AO (10 vs. 22 minutes, P < 0.001). Multivariate logistic regression demonstrated that receiving RT was the strongest predictor of mortality (odds ratio [OR], 6.6; 95% confidence interval [CI], 4.4-9.9; P < 0.001). Time from injury to admission and admission to successful AO were not significant. This finding was consistent in subgroup analysis of RT-only and REBOA-only populations. Conclusions: Despite expedited interventions, time to aortic occlusion did not significantly impact mortality. This may suggest that rapid in-hospital intervention was often insufficient to compensate for severe exsanguination and hypovolemia that had already occurred before emergency department presentation. Selective prehospital advanced resuscitative care closer to the point of injury with {"}scoop and control{"}efforts including hemostatic resuscitation warrants special consideration.",

keywords = "Hemorrhagic shock, aortic occlusion, mortality, resuscitative endovascular balloon occlusion of the aorta, resuscitative thoracotomy",

author = "Broome, {Jacob M.} and Ayman Ali and Simpson, {John T.} and Sherman Tran and Danielle Tatum and Sharven Taghavi and Joseph Dubose and Juan Duchesne and Scalea, {Thomas M.} and Rishi Kundi and William Teeter and Anna Romagnoli and Moore, {Laura J.} and Kenji Inaba and Alice Piccinini and Kauvar, {David S.} and Baggenstoss, {Valorie L.} and Catherine Rauschendorfer and Jeremy Cannon and Mark Seamon and Spalding, {M. Chance} and Wolff, {Timothy W.} and Ernest Moore and Angela Sauia and David Turay and Xian Luo-Owen and David Skarupa and Mull, {Jennifer A.} and Zuniga, {Yohan Diaz} and Joseph Ibrahim and Karen Safcsak and Matthew Yanoff and Kirkpatrick, {Andrew W.} and Ball, {Chad G.} and Zhengwen Xiao and Elizabeth Dauer and Jennifer Knight and Nicole Cornell and Forrest Moore and Matthew Bloom and Tran, {Nam T.} and Eileen Bulger and Ward, {Jeannette G.} and Bini, {John K.} and John Matsuura and Joshua Pringle and Karen Herzing and Kailey Nolan and Nathaniel Poulin and Rachel Nygaard and Chad Richardson and Derek Lumbard and Reagan Bollig and Brian Daley and Niki Rasnake and Marko Bukur and Elizabeth Warnack and Joseph Farhat and Madayag, {Robert M.} and Greg Pinson and Dafney Davare and Seong Lee and Rachele Solomon and James Haan and Kelly Lightwine and Kristin Colling and Megan Brenner and Raul Coimbra and Sho Furata",

year = "2022",

month = oct,

day = "1",

doi = "10.1097/SHK.0000000000001988",

language = "English",

volume = "58",

pages = "275--279",

journal = "Shock",

issn = "1073-2322",

number = "4",

}

Broome, JM, Ali, A, Simpson, JT, Tran, S, Tatum, D, Taghavi, S, Dubose, J, Duchesne, J, Scalea, TM, Kundi, R, Teeter, W, Romagnoli, A, Moore, LJ, Inaba, K, Piccinini, A, Kauvar, DS, Baggenstoss, VL, Rauschendorfer, C, Cannon, J, Seamon, M, Spalding, MC, Wolff, TW, Moore, E, Sauia, A, Turay, D, Luo-Owen, X, Skarupa, D, Mull, JA, Zuniga, YD, Ibrahim, J, Safcsak, K, Yanoff, M, Kirkpatrick, AW, Ball, CG, Xiao, Z, Dauer, E, Knight, J, Cornell, N, Moore, F, Bloom, M, Tran, NT, Bulger, E, Ward, JG, Bini, JK, Matsuura, J, Pringle, J, Herzing, K, Nolan, K, Poulin, N, Nygaard, R, Richardson, C, Lumbard, D, Bollig, R, Daley, B, Rasnake, N, Bukur, M, Warnack, E, Farhat, J, Madayag, RM, Pinson, G, Davare, D, Lee, S, Solomon, R, Haan, J, Lightwine, K, Colling, K, Brenner, M, Coimbra, R & Furata, S 2022, 'IMPACT of TIME to EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION after NONCOMPRESSIBLE TORSO HEMORRHAGE', Shock, vol. 58, no. 4, pp. 275-279. https://doi.org/10.1097/SHK.0000000000001988

TY - JOUR

T1 - IMPACT of TIME to EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION after NONCOMPRESSIBLE TORSO HEMORRHAGE

AU - Broome, Jacob M.

AU - Ali, Ayman

AU - Simpson, John T.

AU - Tran, Sherman

AU - Tatum, Danielle

AU - Taghavi, Sharven

AU - Dubose, Joseph

AU - Duchesne, Juan

AU - Scalea, Thomas M.

AU - Kundi, Rishi

AU - Teeter, William

AU - Romagnoli, Anna

AU - Moore, Laura J.

AU - Inaba, Kenji

AU - Piccinini, Alice

AU - Kauvar, David S.

AU - Baggenstoss, Valorie L.

AU - Rauschendorfer, Catherine

AU - Cannon, Jeremy

AU - Seamon, Mark

AU - Spalding, M. Chance

AU - Wolff, Timothy W.

AU - Moore, Ernest

AU - Sauia, Angela

AU - Turay, David

AU - Luo-Owen, Xian

AU - Skarupa, David

AU - Mull, Jennifer A.

AU - Zuniga, Yohan Diaz

AU - Ibrahim, Joseph

AU - Safcsak, Karen

AU - Yanoff, Matthew

AU - Kirkpatrick, Andrew W.

AU - Ball, Chad G.

AU - Xiao, Zhengwen

AU - Dauer, Elizabeth

AU - Knight, Jennifer

AU - Cornell, Nicole

AU - Moore, Forrest

AU - Bloom, Matthew

AU - Tran, Nam T.

AU - Bulger, Eileen

AU - Ward, Jeannette G.

AU - Bini, John K.

AU - Matsuura, John

AU - Pringle, Joshua

AU - Herzing, Karen

AU - Nolan, Kailey

AU - Poulin, Nathaniel

AU - Nygaard, Rachel

AU - Richardson, Chad

AU - Lumbard, Derek

AU - Bollig, Reagan

AU - Daley, Brian

AU - Rasnake, Niki

AU - Bukur, Marko

AU - Warnack, Elizabeth

AU - Farhat, Joseph

AU - Madayag, Robert M.

AU - Pinson, Greg

AU - Davare, Dafney

AU - Lee, Seong

AU - Solomon, Rachele

AU - Haan, James

AU - Lightwine, Kelly

AU - Colling, Kristin

AU - Brenner, Megan

AU - Coimbra, Raul

AU - Furata, Sho

PY - 2022/10/1

Y1 - 2022/10/1

N2 - Introduction: Time is an essential element in outcomes of trauma patients. The relationship of time to treatment in management of noncompressible torso hemorrhage (NCTH) with resuscitative endovascular balloon occlusion of the aorta (REBOA) or resuscitative thoracotomy (RT) has not been previously described. We hypothesized that shorter times to intervention would reduce mortality. Methods: A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry from 2013 to 2022 was performed to identify patients who underwent emergency department aortic occlusion (AO). Multivariate logistic regression was used to examine the impact of time to treatment on mortality. Results: A total of 1,853 patients (1,245 [67%] RT, 608 [33%] REBOA) were included. Most patients were male (82%) with a median age of 34 years (interquartile range, 30). Median time from injury to admission and admission to successful AO were 31 versus 11 minutes, respectively. Patients who died had shorter median times from injury to successful AO (44 vs. 72 minutes, P < 0.001) and admission to successful AO (10 vs. 22 minutes, P < 0.001). Multivariate logistic regression demonstrated that receiving RT was the strongest predictor of mortality (odds ratio [OR], 6.6; 95% confidence interval [CI], 4.4-9.9; P < 0.001). Time from injury to admission and admission to successful AO were not significant. This finding was consistent in subgroup analysis of RT-only and REBOA-only populations. Conclusions: Despite expedited interventions, time to aortic occlusion did not significantly impact mortality. This may suggest that rapid in-hospital intervention was often insufficient to compensate for severe exsanguination and hypovolemia that had already occurred before emergency department presentation. Selective prehospital advanced resuscitative care closer to the point of injury with "scoop and control"efforts including hemostatic resuscitation warrants special consideration.

AB - Introduction: Time is an essential element in outcomes of trauma patients. The relationship of time to treatment in management of noncompressible torso hemorrhage (NCTH) with resuscitative endovascular balloon occlusion of the aorta (REBOA) or resuscitative thoracotomy (RT) has not been previously described. We hypothesized that shorter times to intervention would reduce mortality. Methods: A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry from 2013 to 2022 was performed to identify patients who underwent emergency department aortic occlusion (AO). Multivariate logistic regression was used to examine the impact of time to treatment on mortality. Results: A total of 1,853 patients (1,245 [67%] RT, 608 [33%] REBOA) were included. Most patients were male (82%) with a median age of 34 years (interquartile range, 30). Median time from injury to admission and admission to successful AO were 31 versus 11 minutes, respectively. Patients who died had shorter median times from injury to successful AO (44 vs. 72 minutes, P < 0.001) and admission to successful AO (10 vs. 22 minutes, P < 0.001). Multivariate logistic regression demonstrated that receiving RT was the strongest predictor of mortality (odds ratio [OR], 6.6; 95% confidence interval [CI], 4.4-9.9; P < 0.001). Time from injury to admission and admission to successful AO were not significant. This finding was consistent in subgroup analysis of RT-only and REBOA-only populations. Conclusions: Despite expedited interventions, time to aortic occlusion did not significantly impact mortality. This may suggest that rapid in-hospital intervention was often insufficient to compensate for severe exsanguination and hypovolemia that had already occurred before emergency department presentation. Selective prehospital advanced resuscitative care closer to the point of injury with "scoop and control"efforts including hemostatic resuscitation warrants special consideration.

KW - Hemorrhagic shock

KW - aortic occlusion

KW - mortality

KW - resuscitative endovascular balloon occlusion of the aorta

KW - resuscitative thoracotomy

UR - http://www.scopus.com/inward/record.url?scp=85140184541&partnerID=8YFLogxK

U2 - 10.1097/SHK.0000000000001988

DO - 10.1097/SHK.0000000000001988

M3 - Article

C2 - 36256624

AN - SCOPUS:85140184541

SN - 1073-2322

VL - 58

SP - 275

EP - 279

JO - Shock

JF - Shock

IS - 4

ER -

IMPACT of TIME to EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION after NONCOMPRESSIBLE TORSO HEMORRHAGE

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