TY - JOUR
T1 - Survival benefit for pelvic trauma patients undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta
T2 - Results of the AAST Aortic Occlusion for Resuscitation in Trauma Acute Care Surgery (AORTA) Registry
AU - The AAST AORTA Study Group
AU - Bini, John K.
AU - Hardman, Claire
AU - Morrison, Jonathon
AU - Scalea, Thomas M.
AU - Moore, Laura J.
AU - Podbielski, Jeanette M.
AU - Inaba, Kenji
AU - Piccinini, Alice
AU - Kauvar, David S.
AU - Cannon, Jeremey
AU - Spalding, Chance
AU - Fox, Charles
AU - Moore, Ernest
AU - DuBose, Joseph J.
N1 - Funding Information:
The AAST Aorta Study Group: Megan Brenner, MD, Thomas M. Scalea, MD, Todd E. Rasmussen, MD, Philip Wasicek, MD, University of Maryland/R Adams Cowley Shock Trauma Center Baltimore, MD, USA; Laura J. Moore, MD, FACS, Jeanette M Podbielski, RN, CCRP, John B. Holcomb, MD, University of Texas Health Sciences Center – Houston, Houston, TX, USA; Kenji Inaba, MD, Los Angeles County + University of Southern California Hospital, Los Angeles, CA, USA; Scott. T. Trexler, MD, Sonya Charo-Griego, RN, Douglas Johnson, LVN, San Antonio Military Medical Center/US Army Institute of Surgical Research San Antonio, TX, USA; Jeremey Cannon, MD; Mark Seamon, MD; Ryan Dumas, MD, University of Pennsylvania, Philadelphia, PA, USA; Charles J. Fox, MD; Eugene Moore, MD, Denver Health and University of Colorado, Denver, Colorado, USA; David Turay, MD, Cassra N. Arbabi, MD, Xian Luo- Owen, PhD, Loma Linda University Medical Center, Loma Linda, CA, USA; David Skarupa, MD, Jennifer A. Mull, RN, CCRC, Joannis Baez Gonzalez, University of Florida – Jacksonville, Jacksonville, FL, USA; Joseph Ibrahim, MD; Karen Safcsak RN, BSN, Orlando Regional Medical Center, Orlando, FL, USA; Stephanie Gordy, MD, Michael Long, MD, Ben Taub General Hospital/ Baylor College of Medicine, Houston, TX, USA, JBSA Fort Sam Houston, TX, USA; Andrew W. Kirkpatrick, MD, Chad Ball, MD; Zhengwen Xiao, MD, MSc, PhD, Foothills Medical Centre, Calgary, Alberta, Canada; Elizabeth Dauer, MD, Temple University, Philadelphia, PA, USA; Jennifer Knight, MD, Nicole Cornell, BS, MS; West Virginia University Hospitals, Morgantown, WV, USA; Joseph Skaja, MD, Rachel Nygaard, PhD, Chad Richardson, MD, Hennepin County Medical Center, Minneapolis, MN, USA; Matthew Bloom, MD, Cedars Sinai Hospital, Los Angeles, CA, USA; Nam T. Tran, MD, Shahram Aarabi, MD, Eileen Bulger, MD; University of Washington – Harborview, Seattle, WA, USA; Forrest “Dell” Moore III, MD, Jeannette G. Ward, MS-CR, Chandler Regional Medical Center, Chandler, AZ, USA; John K. Bini, MD, John Matsuura, MD, Joshua Pringle, MD, Karen Herzing, BSN, RN, Kailey Nolan, BS, Wright State Research Institute – Miami Valley Hospital, Dayton, OH, USA; Nathaniel Poulin, MD, East Carolina Medical Center, Greeneville, NC, USA; William Teeter, MD, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Patricia Carlisle, PhD, Prytime Medical Devices, Inc.
Publisher Copyright:
© 2022
PY - 2022/6
Y1 - 2022/6
N2 - Background: Aortic occlusion (AO) to facilitate the acute resuscitation of trauma and acute care surgery patients in shock remains a controversial topic. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an increasingly deployed method of AO. We hypothesized that in patients with non-compressible hemorrhage below the aortic bifurcation, the use of REBOA instead of open AO may be associated with a survival benefit. Methods: From the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry, we identified 1494 patients requiring AO from 45 Level I and 4 Level II trauma centers. Presentation, intervention, and outcome variables were analyzed to compare REBOA vs open AO in patients with non-compressible hemorrhage below the aortic bifurcation. Results: From December 2014 to January 2019, 217 patients with Zone 3 REBOA or Open AO who required pelvic packing, pelvic fixation or pelvic angio-embolization were identified. Of these, 109 AO patients had injuries isolated to below the aortic bifurcation (REBOA, 84; open AO, 25). Patients with intra-abdominal or thoracic sources of bleeding, above deployment Zone 3 were excluded. Overall mortality was lower in the REBOA group (35.% vs 80%, p <.001). Excluding patients who arrived with CPR in progress, the REBOA group had lower mortality (33.33% vs. 68.75%, p = 0.012). Of the survivors, systemic complications were not significantly different between groups. In the REBOA group, 16 patients had complications secondary to vascular access. Intensive care lengths of stay and ventilator days were both significantly shorter in REBOA patients who survived to discharge. Conclusions: This study compared outcomes for patients with hemorrhage below the aortic bifurcation treated with REBOA to those treated with open AO. Survival was significantly higher in REBOA patients compared to open AO patients, while complications in survivors were not different. Given the higher survival in REBOA patients, we conclude that REBOA should be used for patients with hemorrhagic shock secondary to pelvic trauma instead of open AO.
AB - Background: Aortic occlusion (AO) to facilitate the acute resuscitation of trauma and acute care surgery patients in shock remains a controversial topic. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an increasingly deployed method of AO. We hypothesized that in patients with non-compressible hemorrhage below the aortic bifurcation, the use of REBOA instead of open AO may be associated with a survival benefit. Methods: From the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry, we identified 1494 patients requiring AO from 45 Level I and 4 Level II trauma centers. Presentation, intervention, and outcome variables were analyzed to compare REBOA vs open AO in patients with non-compressible hemorrhage below the aortic bifurcation. Results: From December 2014 to January 2019, 217 patients with Zone 3 REBOA or Open AO who required pelvic packing, pelvic fixation or pelvic angio-embolization were identified. Of these, 109 AO patients had injuries isolated to below the aortic bifurcation (REBOA, 84; open AO, 25). Patients with intra-abdominal or thoracic sources of bleeding, above deployment Zone 3 were excluded. Overall mortality was lower in the REBOA group (35.% vs 80%, p <.001). Excluding patients who arrived with CPR in progress, the REBOA group had lower mortality (33.33% vs. 68.75%, p = 0.012). Of the survivors, systemic complications were not significantly different between groups. In the REBOA group, 16 patients had complications secondary to vascular access. Intensive care lengths of stay and ventilator days were both significantly shorter in REBOA patients who survived to discharge. Conclusions: This study compared outcomes for patients with hemorrhage below the aortic bifurcation treated with REBOA to those treated with open AO. Survival was significantly higher in REBOA patients compared to open AO patients, while complications in survivors were not different. Given the higher survival in REBOA patients, we conclude that REBOA should be used for patients with hemorrhagic shock secondary to pelvic trauma instead of open AO.
KW - REBOA
KW - aortic occlusion
KW - non-compressible
KW - pelvic hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=85127338521&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2022.03.005
DO - 10.1016/j.injury.2022.03.005
M3 - Article
C2 - 35341594
AN - SCOPUS:85127338521
SN - 0020-1383
VL - 53
SP - 2126
EP - 2132
JO - Injury
JF - Injury
IS - 6
ER -