BACKGROUND: Hemorrhage remains the leading cause of death in trauma patients. Proximal aortic occlusion, usually performed by direct aortic cross-clamping via thoracotomy, can provide temporary hemodynamic stability, permitting definitive injury repair. Resuscitative endovascular balloon occlusion of the aorta (REBOA) uses a minimally invasive, transfemoral balloon catheter, which is rapidly inserted retrograde and inflated for aortic occlusion, and may control inflow and allow time for hemostasis. We compared resuscitative thoracotomy with aortic cross-clamping (RT) with REBOA in trauma patients in profound hemorrhagic shock. METHODS: Trauma registry data was used to compare all patients undergoing RT or REBOA during an 18-month period from two Level 1 trauma centers. RESULTS: There was no difference between RT (n = 72) and REBOA groups (n = 24) in terms of demographics, mechanism of injury, or Injury Severity Scores (ISSs). There was no difference in chest and abdominal Abbreviated Injury Scale (AIS) scores between the groups. However, the RT patients had lower extremity AIS score as compared with REBOA patients (1.5 [0-3] vs. 4 [3-4], p < 0.001). Of the 72 RT patients, 45 (62.5%) died in the emergency department, 6 (8.3%) died in the operating room, and 14 (19.4%) died in the intensive care unit. Of the 24 REBOA patients, 4 (16.6%) died in the emergency department, 3 (12.5%) died in the operating room, and 8 (33.3%) died in the intensive care unit. In comparing location of death between the RT and REBOA groups, there were a significantly higher number of deaths in the emergency department among the RT patients as compared with the REBOA patients (62.5% vs. 16.7%, p < 0.001). REBOA had fewer early deaths and improved overall survival as compared with RT (37.5% vs. 9.7%, p = 0.003). CONCLUSION: REBOA is feasible and controls noncompressible truncal hemorrhage in trauma patients in profound shock. Patients undergoing REBOA have improved overall survival and fewer early deaths as compared with patients undergoing RT. LEVEL OF EVIDENCE: Therapeutic study, level IV.
BACKGROUND:Hemorrhage remains the leading cause of death in traumapatients. Proximal aortic occlusion, usually performed by direct aortic cross-clamping via thoracotomy, can provide temporary hemodynamic stability, permitting definitive injury repair. Resuscitative endovascular balloon occlusion of the aorta (REBOA) uses a minimally invasive, transfemoral balloon catheter, which is rapidly inserted retrograde and inflated for aortic occlusion, and may control inflow and allow time for hemostasis. We compared resuscitative thoracotomy with aortic cross-clamping (RT) with REBOA in traumapatients in profound hemorrhagic shock. METHODS:Trauma registry data was used to compare all patients undergoing RT or REBOA during an 18-month period from two Level 1 trauma centers. RESULTS: There was no difference between RT (n = 72) and REBOA groups (n = 24) in terms of demographics, mechanism of injury, or Injury Severity Scores (ISSs). There was no difference in chest and abdominal Abbreviated Injury Scale (AIS) scores between the groups. However, the RT patients had lower extremity AIS score as compared with REBOA patients (1.5 [0-3] vs. 4 [3-4], p < 0.001). Of the 72 RT patients, 45 (62.5%) died in the emergency department, 6 (8.3%) died in the operating room, and 14 (19.4%) died in the intensive care unit. Of the 24 REBOA patients, 4 (16.6%) died in the emergency department, 3 (12.5%) died in the operating room, and 8 (33.3%) died in the intensive care unit. In comparing location of death between the RT and REBOA groups, there were a significantly higher number of deaths in the emergency department among the RT patients as compared with the REBOA patients (62.5% vs. 16.7%, p < 0.001). REBOA had fewer early deaths and improved overall survival as compared with RT (37.5% vs. 9.7%, p = 0.003). CONCLUSION: REBOA is feasible and controls noncompressible truncal hemorrhage in traumapatients in profound shock. Patients undergoing REBOA have improved overall survival and fewer early deaths as compared with patients undergoing RT. LEVEL OF EVIDENCE: Therapeutic study, level IV.
Authors: Ronald Chang; Erin E Fox; Thomas J Greene; Brian J Eastridge; Ramyar Gilani; Kevin K Chung; Stacia M DeSantis; Joseph J DuBose; Jeffrey S Tomasek; Gerald R Fortuna; Valerie G Sams; S Rob Todd; Jeanette M Podbielski; Charles E Wade; John B Holcomb Journal: J Trauma Acute Care Surg Date: 2017-07 Impact factor: 3.313
Authors: Hunter B Moore; Ernest E Moore; Clay C Burlew; Walter L Biffl; Fredric M Pieracci; Carlton C Barnett; Denis D Bensard; Gregory J Jurkovich; Charles J Fox; Angela Sauaia Journal: J Am Coll Surg Date: 2016-04-21 Impact factor: 6.113
Authors: Tiffany Paradis; Omar Bekdache; David Bracco; Jeremy Grushka; Tarek Razek; David Lasry; Andrew Beckett Journal: Can J Surg Date: 2019-04-01 Impact factor: 2.089
Authors: V A Reva; Y Matsumura; T Hörer; D A Sveklov; A V Denisov; S Y Telickiy; A B Seleznev; E R Bozhedomova; J Matsumoto; I M Samokhvalov; J J Morrison Journal: Eur J Trauma Emerg Surg Date: 2016-10-13 Impact factor: 3.693
Authors: Pierre Pezy; Alexandros N Flaris; Nicolas J Prat; François Cotton; Peter W Lundberg; Jean-Louis Caillot; Jean-Stéphane David; Eric J Voiglio Journal: JAMA Surg Date: 2017-04-01 Impact factor: 14.766
Authors: Ramiro Manzano-Nunez; Juan Pablo Herrera-Escobar; Joseph DuBose; Tal Hörer; Samuel Galvagno; Claudia Patricia Orlas; Michael W Parra; Federico Coccolini; Massimo Sartelli; Juan Camilo Falla-Martinez; Alberto Federico García; Julian Chica; Maria Paula Naranjo; Alvaro Ignacio Sanchez; Camilo Jose Salazar; Luis Eduardo Calderón-Tapia; Valeria Lopez-Castilla; Paula Ferrada; Ernest E Moore; Carlos A Ordonez Journal: Eur J Trauma Emerg Surg Date: 2018-03-23 Impact factor: 3.693