IMPACT OF TIME TO EMERGENCY DEPARTMENT RESUSCITATIVE AORTIC OCCLUSION AFTER NONCOMPRESSIBLE TORSO HEMORRHAGE. Issue 4 (6th October 2022)

• Record Type: Journal Article
• Authors: Broome, Jacob M.; Ali, Ayman; Simpson, John T.; Tran, Sherman; Tatum, Danielle; Taghavi, Sharven; DuBose, Joseph; Duchesne, Juan
• Other Names: Scalea Thomas M. author non-byline.; Kundi Rishi author non-byline.; Teeter William author non-byline.; Romagnoli Anna author non-byline.; Moore Laura J. 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 Jeremy author non-byline.; Seamon Mark author non-byline.; Spalding M. Chance author non-byline.; Wolff Timothy W. author non-byline.; Moore Ernest author non-byline.; Sauia Angela author non-byline.; Turay David author non-byline.; Luo-Owen Xian author non-byline.; Skarupa David author non-byline.; Mull Jennifer A. author non-byline.; Zuniga Yohan Diaz author non-byline.; Ibrahim Joseph author non-byline.; Safcsak Karen author non-byline.; Yanoff Matthew 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.; Cornell Nicole 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.; Nygaard Rachel author non-byline.; Richardson Chad author non-byline.; Lumbard 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.; Pinson Greg author non-byline.; Davare Dafney author non-byline.; Lee Seong author non-byline.; Solomon Rachele author non-byline.; Haan James author non-byline.; Lightwine Kelly author non-byline.; Colling Kristin author non-byline.; Brenner Megan author non-byline.; Coimbra Raul author non-byline.; Furata Sho author non-byline.;
• Is Part Of: Shock. Volume 58:Issue 4(2022)
• Page Start: 275
• Page End: 279
• Publication Date: 2022-10-06
• Subjects: Hemorrhagic shock -- aortic occlusion -- resuscitative endovascular balloon occlusion of the aorta -- resuscitative thoracotomy -- mortality; Shock -- Periodicals; Shock -- Periodicals; Choc (Pathologie) -- Périodiques; Shock; Periodicals; 616.0475
• DOI: 10.1097/SHK.0000000000001988
• Languages: English
• ISSNs: 1073-2322

Abstract

Abstract : Shorter time to emergency department aortic occlusion did not improve survival in noncompressible torso hemorrhage. "Scoop and control" with hemostatic resuscitation closer to the point of injury needs special consideration. 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.