Resuscitative endovascular balloon occlusion of the aorta or resuscitative thoracotomy with aortic clamping for noncompressible torso hemorrhage: A retrospective nationwide study.

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging treatment for noncompressible torso hemorrhage. It remains unclear if REBOA is superior to resuscitative thoracotomy with aortic cross-clamping (RT) in terms of improving outcomes. This study compared in-hospital outcomes between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock, using data from a national inpatient database in Japan.
METHODS: Using the Diagnosis Procedure Combination database, we identified patients who received REBOA or RT within 1 day after admission from July 1, 2010, to March 31, 2014. We excluded those with penetrating thoracic injuries. Propensity score-adjusted analyses were performed to compare in-hospital mortality and other in-hospital outcomes.
RESULTS: Eligible patients (n = 259) were classified into the REBOA group (n = 191) or the RT group (n = 68). In the propensity score-adjusted Cox regression analysis, the two groups did not differ significantly with respect to in-hospital mortality (hazard ratio, 0.94; 95% confidence interval, 0.60-1.48). There were also no significant differences between the groups in ventilator-free days, intensive care unit-free days, total amount of fluid infusion within 1 day after admission, total amount of transfusion within 1 day after admission, or total hospitalization costs.
CONCLUSION: In this retrospective nationwide study, in-hospital outcomes were not significantly different between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock. LEVEL OF EVIDENCE: Therapeutic/care management, level III.