Intraoperative REBOA: an analysis of the American Association for the Surgery of Trauma AORTA registry. Issue 1 (11th November 2019)

• Record Type: Journal Article
• Authors: Vella, Michael A; Dumas, Ryan Peter; DuBose, Joseph; Morrison, Jonathan; Scalea, Thomas; Moore, Laura; Podbielski, Jeanette; Inaba, Kenji; Piccinini, Alice; Kauvar, David S; Baggenstoss, Valorie L; Spalding, Chance; Fox, Charles; Moore, Ernest E; Cannon, Jeremy W
• Other Names: author non-byline.; Morrison Jonny author non-byline.; Scalea Thomas M author non-byline.; Moore Laura J author non-byline.; Podbielski Jeanette M author non-byline.; Holcomb John B author non-byline.; Inaba Kenji author non-byline.; Piccinini Alice author non-byline.; Kauvar David S author non-byline.; Baggenstoss Valorie L author non-byline.; Rauschendorfer Catherine author non-byline.; Cannon Jeremey author non-byline.; Seamon Mark author non-byline.; Dumas Ryan author non-byline.; Vella Michael author non-byline.; Guzman Jessica author non-byline.; Spalding Chance author non-byline.; Wolff Timothy W author non-byline.; Fox Chuck author non-byline.; Moore Ernest author non-byline.; Turay David author non-byline.; Arbabi Cassra N author non-byline.; Luo-Owen Xian author non-byline.; Skarupa David author non-byline.; Mull Jennifer A author non-byline.; Gonzalez Joannis Baez author non-byline.; Ibrahim Joseph author non-byline.; Safcsak Karen author non-byline.; Gordy Stephanie author non-byline.; Long Michael author non-byline.; Kirkpatrick Andrew W author non-byline.; Ball Chad G author non-byline.; Xiao Zhengwen author non-byline.; Dauer Elizabeth author non-byline.; Knight Jennifer author non-byline.; Moore Forrest "Dell" author non-byline.; Bloom Matthew author non-byline.; Tran Nam T author non-byline.; Bulger Eileen author non-byline.; Ward Jeannette G author non-byline.; Bini John K author non-byline.; Matsuura John author non-byline.; Pringle Joshua author non-byline.; Herzing Karen author non-byline.; Nolan Kailey author non-byline.; Poulin Nathaniel author non-byline.; Teeter William author non-byline.; Nygaard Rachel author non-byline.; Richardson Chad author non-byline.; Skaja Joseph author non-byline.; Lombard Derek author non-byline.; Bollig Reagan author non-byline.; Daley Brian author non-byline.; Rasnake Niki author non-byline.; Bukur Marko author non-byline.; Warnack Elizabeth author non-byline.; Farhat Joseph author non-byline.; Madayag Robert M author non-byline.; Bourg Pamela author non-byline.;
• Is Part Of: Trauma surgery & acute care open. Volume 4:Issue 1(2019)
• Publication Date: 2019-11-11
• Subjects: resuscitation for Shock -- hemorrhagic shock -- emergency department thoracotomy -- endovascular procedures; Traumatology -- Periodicals; Critical care medicine -- Periodicals; Wounds and injuries -- Periodicals; 617.1
• DOI: 10.1136/tsaco-2019-000340
• Languages: English
• ISSNs: 2397-5776

Abstract

Abstract : Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality. Methods: The American Association for the Surgery of Trauma AORTA registry was used to identify patients undergoing REBOA. Injury characteristics and outcomes data were compared between OR and ED groups. The primary outcome was in-hospital mortality; secondary outcomes included total AO time, transfusion requirements, and acute kidney injury. Results: Location and timing of catheter insertion were available for 305 of 321 (95%) subjects. 58 patients underwent REBOA in the OR (19%). There were no differences with respect to sex, admission lactate, and Injury Severity Score. The OR group was younger (33 years vs. 41 years, p=0.01) and with more penetrating injuries (36% vs. 15%, p<0.001). There were significant differences with respect to admission physiology. Time from admission to AO was longer in the OR group (75 minutes vs. 23 minutes, p<0.001) as was time to definitive hemostasis (116 minutes vs. 79 minutes, p=0.01). Unadjusted mortality was lower in the OR group (36.2% vs. 68.8%, p<0.001). There were no differences in secondary outcomes. After controlling for covariates, there was no association between insertion location and in-hospital mortality (OR 1.8, 95% CI 0.30 to 11.50). Discussion: OR REBOA placement is common and generally employed in patients with more stable admission physiology. OR placement was not associated with increased in-hospital mortality despite longer times to AO and definite hemostasis when compared with catheters placed in the ED. Level of evidence: IV; therapeutic/care management.