TY - JOUR
T1 - Temporal changes in reboa utilization practices are associated with increased survival
T2 - An analysis of the aorta registry
AU - Bukur, Marko
AU - Gorman, Elizabeth
AU - DiMaggio, Charles
AU - Frangos, Spiros
AU - Morrison, Jonathan J.
AU - Scalea, Thomas M.
AU - Moore, Laura J.
AU - Podbielski, Jeanette
AU - Inaba, Kenji
AU - Kauvar, David
AU - Cannon, Jeremy W.
AU - Seamon, Mark J.
AU - Spalding, M. Chance
AU - Fox, Charles
AU - DuBose, Joseph J.
N1 - Publisher Copyright:
Copyright ß 2020 by the Shock Society
PY - 2021/1
Y1 - 2021/1
N2 - Background: Aortic occlusion (AO) is utilized for patients in extremis, with resuscitative endovascular balloon occlusion of the aorta (REBOA) use increasing. Our objective was to examine changes in AO practices and outcomes over time. The primary outcome was the temporal variation in AO mortality, while secondary outcomes included changes in technique, utilization, and complications. Study Design: This study examined the AORTA registry over a 5-year period (2014–2018). AO outcomes and utilization were analyzed using year of procedure as an independent variable. A multivariable model adjusting for year of procedure, signs of life (SOL), SBP at AO initiation, operator level, timing of AO, and hemodynamic response to AO was created to analyze AO mortality. Results: One thousand four hundred fifty-eight AO were included. Mean age (39.1 16.7) and median ISS (34[25,49]) were comparable between REBOA and open AO. Open AO patients were more likely: male (84% vs. 77%, P ¼ 0.001), s/p penetrating trauma (61% vs. 19%, P < 0.001), and arrived without SOL (60% vs. 40%, P ¼ 0.001). REBOA use increased significantly and adjusted mortality decreased 22%/year while open AO survival was unchanged. REBOA initiation SBP increased significantly over the study period (52.2 vs. 65, P ¼ 0.04). Compared with patients undergoing AO with CPR, each decile increase in SBP improved survival 12% (AOR 1.12, adj P ¼ 0.001). The use of 7F REBOA (2.9%–54.8%) and Zone III deployment increased significantly (14.7% vs 40.6%), with Zone III placement having decreased associated mortality (AOR 0.33, adj P ¼ 0.001). Overall REBOA complication rate was 4.5% and did not increase over time (P ¼ 0.575). Conclusions: REBOA survival has increased significantly while open AO survival remained unchanged. This may be related to lower thresholds for REBOA insertion at higher blood pressures, increased operator experience, and improved catheter technology leading to earlier deployment.
AB - Background: Aortic occlusion (AO) is utilized for patients in extremis, with resuscitative endovascular balloon occlusion of the aorta (REBOA) use increasing. Our objective was to examine changes in AO practices and outcomes over time. The primary outcome was the temporal variation in AO mortality, while secondary outcomes included changes in technique, utilization, and complications. Study Design: This study examined the AORTA registry over a 5-year period (2014–2018). AO outcomes and utilization were analyzed using year of procedure as an independent variable. A multivariable model adjusting for year of procedure, signs of life (SOL), SBP at AO initiation, operator level, timing of AO, and hemodynamic response to AO was created to analyze AO mortality. Results: One thousand four hundred fifty-eight AO were included. Mean age (39.1 16.7) and median ISS (34[25,49]) were comparable between REBOA and open AO. Open AO patients were more likely: male (84% vs. 77%, P ¼ 0.001), s/p penetrating trauma (61% vs. 19%, P < 0.001), and arrived without SOL (60% vs. 40%, P ¼ 0.001). REBOA use increased significantly and adjusted mortality decreased 22%/year while open AO survival was unchanged. REBOA initiation SBP increased significantly over the study period (52.2 vs. 65, P ¼ 0.04). Compared with patients undergoing AO with CPR, each decile increase in SBP improved survival 12% (AOR 1.12, adj P ¼ 0.001). The use of 7F REBOA (2.9%–54.8%) and Zone III deployment increased significantly (14.7% vs 40.6%), with Zone III placement having decreased associated mortality (AOR 0.33, adj P ¼ 0.001). Overall REBOA complication rate was 4.5% and did not increase over time (P ¼ 0.575). Conclusions: REBOA survival has increased significantly while open AO survival remained unchanged. This may be related to lower thresholds for REBOA insertion at higher blood pressures, increased operator experience, and improved catheter technology leading to earlier deployment.
KW - Aortic occlusion
KW - Endovascular
KW - Outcomes
KW - REBOA
KW - Survival
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85098742281&partnerID=8YFLogxK
U2 - 10.1097/SHK.0000000000001586
DO - 10.1097/SHK.0000000000001586
M3 - Article
C2 - 32842023
AN - SCOPUS:85098742281
SN - 1073-2322
VL - 55
SP - 24
EP - 32
JO - Shock
JF - Shock
IS - 1
ER -