Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

Ramiro Manzano-Nunez*, David McGreevy, Claudia P. Orlas, Alberto F. Garciá, Tal M. Hörer, Joseph Dubose, Carlos A. Ordoñez, Jonny Morrison, Thomas M. Scalea, Laura J. Moore, Jeanette M. Podbielski, John B. Holcomb, Kenji Inaba, Alice Piccinini, David S. Kauvar, Valorie L. Baggenstoss, Catherine Rauschendorfer, Jeremey Cannon, Mark Seamon, Ryan DumasMike Vella, Jessica Guzman, Chance Spalding, Timothy W. Wolff, Chuck Fox, Ernest Moore, David Turay, Cassra N. Arbabi, Xian Luo-Owen, David Skarupa, Jennifer A. Mull, Joannis Baez Gonzalez, Joseph Ibrahim, Karen Safcsak, Stephanie Gordy, Michael Long, Andrew W. Kirkpatrick, Chad G. Ball, Zhengwen Xiao, Elizabeth Dauer, Jennifer Knight, Nicole Cornell, Forrest Dell Moore, Matthew Bloom, Nam T. Tran, Eileen Bulger, Jeannette G. Ward, John K. Bini, John Matsuura, Joshua Pringle, Karen Herzing, Kailey Nolan, Nathaniel Poulin, William Teeter, Rachel Nygaard, Chad Richardson, Joseph Skaja, Derek Lombard, Reagan Bollig, Brian Daley, Niki Rasnake, Marko Bukur, Elizabeth Warnack, Joseph Farhat, Robert M. Madayag, Pamela Bourg, Anna Ramstedt, Mitra Sadeghi, Kristofer F. Nilsson, Thomas Larzon, Artai Pirouzram, Asko Toivola, Mariusz Maszkowski, Adam Bersztel, Per Skoog, Koji Idoguchi, Yuri Kon, Tokiya Ishida, Yosuke Matsumura, Junichi Matsumoto, Viktor Reva, Eva Corina Caragounis, Mårten Falkenberg, Lauri Handolin, George Oosthuizen, Endre Szarka, Vassil Manchev, Tongporn Wannatoop, Sung W. Chang, Boris Kessel, Dan Hebron, Gad Shaked, Miklosh Bala, Federico Coccolini, Luca Ansaloni, Peter Hibert-Carius, Michelle Moe, Suzanne Maria Vrancken

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results: A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36-1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63-3,33; p = 0.3). Conclusion: There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.

Original languageEnglish
Article number57
JournalWorld Journal of Emergency Surgery
Issue number1
StatePublished - 12 Oct 2020


  • Income of countries
  • Trauma


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