Intraoperative REBOA: an analysis of the American Association for the Surgery of Trauma AORTA registry.
emergency department thoracotomy
endovascular procedures
hemorrhagic shock
resuscitation for Shock
Journal
Trauma surgery & acute care open
ISSN: 2397-5776
Titre abrégé: Trauma Surg Acute Care Open
Pays: England
ID NLM: 101698646
Informations de publication
Date de publication:
2019
2019
Historique:
received:
03
06
2019
revised:
08
08
2019
accepted:
10
08
2019
entrez:
5
12
2019
pubmed:
5
12
2019
medline:
5
12
2019
Statut:
epublish
Résumé
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality. The American Association for the Surgery of Trauma AORTA registry was used to identify patients undergoing REBOA. Injury characteristics and outcomes data were compared between OR and ED groups. The primary outcome was in-hospital mortality; secondary outcomes included total AO time, transfusion requirements, and acute kidney injury. Location and timing of catheter insertion were available for 305 of 321 (95%) subjects. 58 patients underwent REBOA in the OR (19%). There were no differences with respect to sex, admission lactate, and Injury Severity Score. The OR group was younger (33 years vs. 41 years, p=0.01) and with more penetrating injuries (36% vs. 15%, p<0.001). There were significant differences with respect to admission physiology. Time from admission to AO was longer in the OR group (75 minutes vs. 23 minutes, p<0.001) as was time to definitive hemostasis (116 minutes vs. 79 minutes, p=0.01). Unadjusted mortality was lower in the OR group (36.2% vs. 68.8%, p<0.001). There were no differences in secondary outcomes. After controlling for covariates, there was no association between insertion location and in-hospital mortality (OR 1.8, 95% CI 0.30 to 11.50). OR REBOA placement is common and generally employed in patients with more stable admission physiology. OR placement was not associated with increased in-hospital mortality despite longer times to AO and definite hemostasis when compared with catheters placed in the ED. IV; therapeutic/care management.
Sections du résumé
BACKGROUND
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality.
METHODS
METHODS
The American Association for the Surgery of Trauma AORTA registry was used to identify patients undergoing REBOA. Injury characteristics and outcomes data were compared between OR and ED groups. The primary outcome was in-hospital mortality; secondary outcomes included total AO time, transfusion requirements, and acute kidney injury.
RESULTS
RESULTS
Location and timing of catheter insertion were available for 305 of 321 (95%) subjects. 58 patients underwent REBOA in the OR (19%). There were no differences with respect to sex, admission lactate, and Injury Severity Score. The OR group was younger (33 years vs. 41 years, p=0.01) and with more penetrating injuries (36% vs. 15%, p<0.001). There were significant differences with respect to admission physiology. Time from admission to AO was longer in the OR group (75 minutes vs. 23 minutes, p<0.001) as was time to definitive hemostasis (116 minutes vs. 79 minutes, p=0.01). Unadjusted mortality was lower in the OR group (36.2% vs. 68.8%, p<0.001). There were no differences in secondary outcomes. After controlling for covariates, there was no association between insertion location and in-hospital mortality (OR 1.8, 95% CI 0.30 to 11.50).
DISCUSSION
CONCLUSIONS
OR REBOA placement is common and generally employed in patients with more stable admission physiology. OR placement was not associated with increased in-hospital mortality despite longer times to AO and definite hemostasis when compared with catheters placed in the ED.
LEVEL OF EVIDENCE
METHODS
IV; therapeutic/care management.
Identifiants
pubmed: 31799415
doi: 10.1136/tsaco-2019-000340
pii: tsaco-2019-000340
pmc: PMC6861115
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e000340Investigateurs
Jonny Morrison
(J)
Thomas M Scalea
(TM)
Laura J Moore
(LJ)
Jeanette M Podbielski
(JM)
John B Holcomb
(JB)
Kenji Inaba
(K)
Alice Piccinini
(A)
David S Kauvar
(DS)
Valorie L Baggenstoss
(VL)
Catherine Rauschendorfer
(C)
Jeremey Cannon
(J)
Mark Seamon
(M)
Ryan Dumas
(R)
Michael Vella
(M)
Jessica Guzman
(J)
Chance Spalding
(C)
Timothy W Wolff
(TW)
Chuck Fox
(C)
Ernest Moore
(E)
David Turay
(D)
Cassra N Arbabi
(CN)
Xian Luo-Owen
(X)
David Skarupa
(D)
Jennifer A Mull
(JA)
Joannis Baez Gonzalez
(JB)
Joseph Ibrahim
(J)
Karen Safcsak
(K)
Stephanie Gordy
(S)
Michael Long
(M)
Andrew W Kirkpatrick
(AW)
Chad G Ball
(CG)
Zhengwen Xiao
(Z)
Elizabeth Dauer
(E)
Jennifer Knight
(J)
Forrest Dell Moore
(FD)
Matthew Bloom
(M)
Nam T Tran
(NT)
Eileen Bulger
(E)
Jeannette G Ward
(JG)
John K Bini
(JK)
John Matsuura
(J)
Joshua Pringle
(J)
Karen Herzing
(K)
Kailey Nolan
(K)
Nathaniel Poulin
(N)
William Teeter
(W)
Rachel Nygaard
(R)
Chad Richardson
(C)
Joseph Skaja
(J)
Derek Lombard
(D)
Reagan Bollig
(R)
Brian Daley
(B)
Niki Rasnake
(N)
Marko Bukur
(M)
Elizabeth Warnack
(E)
Joseph Farhat
(J)
Robert M Madayag
(RM)
Pamela Bourg
(P)
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: The following conflicts of interest pertain to Prytime Medical Devices: University of Pennsylvania Simulation Center (REBOA simulation equipment); EEM (research support); JM (clinical advisory board); CF (medical consultant); and CS (unpaid speaker).
Références
J Trauma Acute Care Surg. 2015 May;78(5):1054-8
pubmed: 25909430
J Trauma. 2006 Jun;60(6 Suppl):S3-11
pubmed: 16763478
Resuscitation. 2015 Nov;96:275-9
pubmed: 26386370
J Trauma Acute Care Surg. 2015 Oct;79(4):523-30; discussion 530-2
pubmed: 26402524
Injury. 2018 Sep;49(9):1687-1692
pubmed: 29866625
J Trauma Acute Care Surg. 2017 Jun;82(6S Suppl 1):S2-S8
pubmed: 28333835
Trauma Surg Acute Care Open. 2018 Jan 13;3(1):e000154
pubmed: 29766135
J Surg Res. 2014 Oct;191(2):423-31
pubmed: 24836421
J Trauma. 2011 Dec;71(6):1869-72
pubmed: 22182896
Crit Care Med. 2018 Mar;46(3):447-453
pubmed: 29474326
J Trauma Acute Care Surg. 2016 Sep;81(3):409-19
pubmed: 27050883
J Trauma Acute Care Surg. 2013 Sep;75(3):506-11
pubmed: 24089121
Injury. 2009 Sep;40(9):907-11
pubmed: 19540488
JAMA Surg. 2018 Feb 1;153(2):130-135
pubmed: 28973104
J Trauma Acute Care Surg. 2017 Sep;83(3):464-468
pubmed: 28598906
J Trauma Acute Care Surg. 2014 May;76(5):1251-8
pubmed: 24747456
Scand J Trauma Resusc Emerg Med. 2016 Feb 09;24:13
pubmed: 26861070
Eur J Trauma Emerg Surg. 2018 Aug;44(4):491-501
pubmed: 28801841
Surg Clin North Am. 2012 Aug;92(4):843-58, vii
pubmed: 22850150
J Trauma Acute Care Surg. 2018 May;84(5):809-818
pubmed: 29401189
BMC Med Res Methodol. 2014 Mar 20;14:41
pubmed: 24650044
Int J Surg Case Rep. 2015;13:15-8
pubmed: 26074486
Surgery. 2013 Jun;153(6):848-56
pubmed: 23453327
J Trauma Acute Care Surg. 2015 May;78(5):897-903; discussion 904
pubmed: 25909407
J Trauma Acute Care Surg. 2017 Dec;83(6):1161-1164
pubmed: 29190256
J Trauma Acute Care Surg. 2016 Feb;80(2):324-34
pubmed: 26816219
Am J Surg. 2016 Dec;212(6):1101-1105
pubmed: 27832843
Eur J Trauma Emerg Surg. 2019 Aug;45(4):713-718
pubmed: 29922894
J Trauma. 2002 Mar;52(3):420-5
pubmed: 11901314
Am Surg. 2017 Apr 1;83(4):337-340
pubmed: 28424126
J Trauma Acute Care Surg. 2016 Oct;81(4):685-91
pubmed: 27488491
J Trauma Acute Care Surg. 2018 Sep;85(3):507-511
pubmed: 30142104
J Am Coll Surg. 2018 May;226(5):730-740
pubmed: 29421694