Megan Brenner1, Kenji Inaba2, Alberto Aiolfi2, Joseph DuBose3, Timothy Fabian4, Tiffany Bee4, John B Holcomb5, Laura Moore5, David Skarupa6, Thomas M Scalea3. 1. R Adams Cowley Shock Trauma Center, University of Maryland Shock Trauma Center, Baltimore, MD. Electronic address: mbrenner@umm.edu. 2. Division of Surgical Critical Care and Trauma, Los Angeles County + University of Southern California Hospital, Los Angeles, CA. 3. R Adams Cowley Shock Trauma Center, University of Maryland Shock Trauma Center, Baltimore, MD. 4. Division of Trauma and Surgical Critical Care, University of Tennessee, Memphis, TN. 5. Division of Trauma and Surgical Critical Care, University of Texas, Houston, TX. 6. Division of Trauma and Surgical Critical Care, University of Florida, Jacksonville, FL.
Abstract
BACKGROUND: Aortic occlusion is a potentially valuable tool for early resuscitation in patients nearing extremis or in arrest from severe hemorrhage. STUDY DESIGN: The American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry identified trauma patients without penetrating thoracic injury undergoing aortic occlusion at the level of the descending thoracic aorta (resuscitative thoracotomy [RT] or zone 1 resuscitative endovascular balloon occlusion of the aorta [REBOA]) in the emergency department (ED). Survival outcomes relative to the timing of CPR need and admission hemodynamic status were examined. RESULTS: Two hundred and eighty-five patients were included: 81.8% were males, with injury due to penetrating mechanisms in 41.4%; median age was 35.0 years (interquartile range 29 years) and median Injury Severity Score was 34.0 (interquartile range 18). Resuscitative thoracotomy was used in 71%, and zone 1 REBOA in 29%. Overall survival beyond the ED was 50% (RT 44%, REBOA 63%; p = 0.004) and survival to discharge was 5% (RT 2.5%, REBOA 9.6%; p = 0.023). Discharge Glasgow Coma Scale score was 15 in 85% of survivors. Prehospital CPR was required in 60% of patients with a survival beyond the ED of 37% and survival to discharge of 3% (all p > 0.05). Patients who did not require any CPR before had a survival beyond the ED of 70% (RT 48%, REBOA 93%; p < 0.001) and survival to discharge of 13% (RT 3.4%, REBOA 22.2%, p = 0.048). If aortic occlusion patients did not require CPR but presented with hypotension (systolic blood pressure <90 mmHg; 9% [65% RT; 35% REBOA]), they achieved survival beyond the ED in 65% (p = 0.009) and survival to discharge of 15% (RT 0%, REBOA 44%; p = 0.008). CONCLUSIONS: Overall, REBOA can confer a survival benefit over RT, particularly in patients not requiring CPR. Considerable additional study is required to definitively recommend REBOA for specific subsets of injured patients.
BACKGROUND:Aortic occlusion is a potentially valuable tool for early resuscitation in patients nearing extremis or in arrest from severe hemorrhage. STUDY DESIGN: The American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry identified traumapatients without penetrating thoracic injury undergoing aortic occlusion at the level of the descending thoracic aorta (resuscitative thoracotomy [RT] or zone 1 resuscitative endovascular balloon occlusion of the aorta [REBOA]) in the emergency department (ED). Survival outcomes relative to the timing of CPR need and admission hemodynamic status were examined. RESULTS: Two hundred and eighty-five patients were included: 81.8% were males, with injury due to penetrating mechanisms in 41.4%; median age was 35.0 years (interquartile range 29 years) and median Injury Severity Score was 34.0 (interquartile range 18). Resuscitative thoracotomy was used in 71%, and zone 1 REBOA in 29%. Overall survival beyond the ED was 50% (RT 44%, REBOA 63%; p = 0.004) and survival to discharge was 5% (RT 2.5%, REBOA 9.6%; p = 0.023). Discharge Glasgow Coma Scale score was 15 in 85% of survivors. Prehospital CPR was required in 60% of patients with a survival beyond the ED of 37% and survival to discharge of 3% (all p > 0.05). Patients who did not require any CPR before had a survival beyond the ED of 70% (RT 48%, REBOA 93%; p < 0.001) and survival to discharge of 13% (RT 3.4%, REBOA 22.2%, p = 0.048). If aortic occlusionpatients did not require CPR but presented with hypotension (systolic blood pressure <90 mmHg; 9% [65% RT; 35% REBOA]), they achieved survival beyond the ED in 65% (p = 0.009) and survival to discharge of 15% (RT 0%, REBOA 44%; p = 0.008). CONCLUSIONS: Overall, REBOA can confer a survival benefit over RT, particularly in patients not requiring CPR. Considerable additional study is required to definitively recommend REBOA for specific subsets of injured patients.
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
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Authors: Christina M Theodorou; Jamie E Anderson; Megan Brenner; Thomas M Scalea; Kenji Inaba; Jeremy Cannon; Mark Seamon; M Chance Spalding; Charles J Fox; Ernest E Moore; Joseph J DuBose; Joseph M Galante Journal: J Surg Res Date: 2020-04-17 Impact factor: 2.192
Authors: James W Davis; Rachel C Dirks; David R Jeffcoach; Krista L Kaups; Lawrence P Sue; Jordan T Lilienstein; Mary M Wolfe; Amy M Kwok Journal: Trauma Surg Acute Care Open Date: 2021-06-17