Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the presence of associated severe traumatic brain injury: A propensity-score matched study.
Outcomes
Resuscitative endovascular balloon occlusion of the aorta
Traumatic brain injury
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
13 Jun 2024
13 Jun 2024
Historique:
received:
12
05
2024
revised:
04
06
2024
accepted:
12
06
2024
medline:
30
6
2024
pubmed:
30
6
2024
entrez:
29
6
2024
Statut:
aheadofprint
Résumé
Experimental work suggested that resuscitative Endovascular Balloon Occlusion of the aorta (REBOA) preserves cerebral circulation in animal models of traumatic brain injury. No clinical work has evaluated the role of REBOA in the presence of associated severe traumatic brain injury (TBI). We investigated the impacts of REBOA on neurological and survival outcomes. Propensity-score matched study, using the American College of Surgeons Trauma Quality Improvement Program database. Patients with severe TBI patients (Abbreviated Injury Scale ≥3) receiving REBOA within 4 h from arrival were matched with similar patients not receiving REBOA. Neurological matching included head AIS, pupils, and midline shift. Clinical outcomes were compared between the two groups. 434 REBOA patients were matched with 859 patients without REBOA. Patients in the REBOA group had higher rates of in-hospital mortality (63.6 % vs 44.2 %, p < 0.001), severe sepsis (4.4 % vs 2.2 %, p = 0.029), acute kidney injury (10.1 % vs 6.6 %, p = 0.029), and withdrawal of life support (25.4 % vs 19.6 %, p = 0.020) despite of lower craniectomy/craniotomy rate (7.1 % vs 12.7 %, p < 0.002). In patients with severe TBI, REBOA use is associated with an increased risk of in-hospital mortality, AKI, and infectious complications.
Sections du résumé
BACKGROUND
BACKGROUND
Experimental work suggested that resuscitative Endovascular Balloon Occlusion of the aorta (REBOA) preserves cerebral circulation in animal models of traumatic brain injury. No clinical work has evaluated the role of REBOA in the presence of associated severe traumatic brain injury (TBI). We investigated the impacts of REBOA on neurological and survival outcomes.
METHODS
METHODS
Propensity-score matched study, using the American College of Surgeons Trauma Quality Improvement Program database. Patients with severe TBI patients (Abbreviated Injury Scale ≥3) receiving REBOA within 4 h from arrival were matched with similar patients not receiving REBOA. Neurological matching included head AIS, pupils, and midline shift. Clinical outcomes were compared between the two groups.
RESULTS
RESULTS
434 REBOA patients were matched with 859 patients without REBOA. Patients in the REBOA group had higher rates of in-hospital mortality (63.6 % vs 44.2 %, p < 0.001), severe sepsis (4.4 % vs 2.2 %, p = 0.029), acute kidney injury (10.1 % vs 6.6 %, p = 0.029), and withdrawal of life support (25.4 % vs 19.6 %, p = 0.020) despite of lower craniectomy/craniotomy rate (7.1 % vs 12.7 %, p < 0.002).
CONCLUSION
CONCLUSIONS
In patients with severe TBI, REBOA use is associated with an increased risk of in-hospital mortality, AKI, and infectious complications.
Identifiants
pubmed: 38944625
pii: S0002-9610(24)00326-X
doi: 10.1016/j.amjsurg.2024.115798
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
115798Informations de copyright
Copyright © 2024 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare that there are no conflicts of interest related to this manuscript. The only assistance from generative artificial intelligence technology is grammar check to ensure the clarity and fluency of the manuscript.