Ryo Yamamoto1, Ramon F Cestero2, Mark T Muir2, Donald H Jenkins2, Brian J Eastridge2, Tomohiro Funabiki3, Junichi Sasaki4. 1. Trauma Service/Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan; Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA. Electronic address: ryo.yamamoto@gmail.com. 2. Department of Surgery, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA. 3. Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumiku, Yokohama, Kanagawa, 230-8765, Japan. 4. Trauma Service/Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
Abstract
BACKGROUND: The optimal candidates for resuscitative endovascular balloon occlusion of the aorta (REBOA) remain unclear. We hypothesized that patients who experience delays in surgical intervention would benefit from REBOA. METHODS: Using the Japan Trauma Databank (2014-2019), patients transferred to the operating room (OR) within 3 h were identified. Patients treated with REBOA were matched with those without REBOA using propensity scores, and further divided based on the transfer time to OR: ≤ 1 h (early), 1-2 h (delayed), and >2 h (significantly-delayed). Survival to discharge was compared. RESULTS: Among 5258 patients, 310 underwent REBOA. In 223 matched pairs, patients treated with REBOA had improved survival (56.5% vs. 31.8%; p < 0.01), although in-hospital mortality was reduced by REBOA only in the delayed and significantly-delayed subgroups (HR = 0.43 [0.28-0.65] and 0.42 [0.25-0.71]). CONCLUSIONS: REBOA-treated trauma patients who experience delays in surgical intervention (>1 h) have improved survival.
BACKGROUND: The optimal candidates for resuscitative endovascular balloon occlusion of the aorta (REBOA) remain unclear. We hypothesized that patients who experience delays in surgical intervention would benefit from REBOA. METHODS: Using the Japan Trauma Databank (2014-2019), patients transferred to the operating room (OR) within 3 h were identified. Patients treated with REBOA were matched with those without REBOA using propensity scores, and further divided based on the transfer time to OR: ≤ 1 h (early), 1-2 h (delayed), and >2 h (significantly-delayed). Survival to discharge was compared. RESULTS: Among 5258 patients, 310 underwent REBOA. In 223 matched pairs, patients treated with REBOA had improved survival (56.5% vs. 31.8%; p < 0.01), although in-hospital mortality was reduced by REBOA only in the delayed and significantly-delayed subgroups (HR = 0.43 [0.28-0.65] and 0.42 [0.25-0.71]). CONCLUSIONS: REBOA-treated traumapatients who experience delays in surgical intervention (>1 h) have improved survival.
Authors: Christina M Theodorou; Laura A Galganski; Gregory J Jurkovich; Diana L Farmer; Shinjiro Hirose; Jacob T Stephenson; A Francois Trappey Journal: J Trauma Acute Care Surg Date: 2021-03-01 Impact factor: 3.697