Balloon Rises Above: REBOA at Zone 1 May Be Superior to Resuscitative Thoracotomy.

BACKGROUND

The use of Zone 1 REBOA for life-threatening trauma has increased dramatically.

STUDY DESIGN

The AORTA database was queried for blunt and penetrating trauma between 2013-2021. Outcomes were examined for both mechanisms of injury combined and separately and for combinations of abdominal injury with and without TBI and chest injuries (AIS>2).

RESULTS

531 patients underwent REBOA (408 blunt, 123 penetrating), and 1,603 (595 blunt,1,008 penetrating) underwent RT. Mean age was 38.5 ± 16, mean ISS was 34.5 ± 21; 57.7% had chest AIS >2, 21.8% had head AIS >2, and 37.3% had abdominal AIS >2. Admission GCS was 4.9+4, and SBP at aortic occlusion (AO) was 22+40. No differences in outcomes in REBOA or RT patients were identified between institutions (p>0.5). After inverse probability weighting, GCS, age, ISS, SBP at AO, CPR at AO, and blood product transfusion, REBOA was superior to RT in both blunt (OR 4.7,1.9-11.7) and penetrating injury (OR 4.9, 1.7-14), across all spectrums of injury (p<0.01). Overall mortality was significantly higher for AO >90 minutes (min) compared to <30 min in blunt (OR 4.6,1.5-15) and penetrating injury (OR 5.4,1.1-25). Duration of AO>60 min was significantly associated with mortality after penetrating abdominal injury (OR 5.1, 1.1-22) and abdomen and head (OR 5.3, 1.6-18).

CONCLUSION

In-hospital survival is higher for patients undergoing REBOA than RT for all injury patterns. Complete AO by REBOA or RT should be limited to less than 30 minutes. Neither hospital and procedure volume nor trauma verification level impacts outcomes for REBOA or RT.

Informations de copyright

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