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

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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 languageEnglish
Pages (from-to)275-279
Number of pages5
JournalShock
Volume58
Issue number4
DOIs
StatePublished - 1 Oct 2022

Keywords

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

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