Abstract 15058: Resuscitative Endovascular Balloon Occlusion of the Aorta versus Aortic Cross Clamping Among Patients With Critical Trauma: A Nationwide Cohort Study in Japan
Introduction: Measures of aortic occlusion for resuscitation in patients with severe torso trauma remain controversial.
Hypothesis: Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be an alternative method to resuscitative aortic cross-clamping (ACC) among patients with critical trauma.
Methods: This study was a retrospective cohort study between 2004 and 2013 from a nationwide trauma registry in Japan (Japan Trauma Data Bank). Participant’s criteria were adult patients who underwent REBOA or ACC. We excluded patients with cardiopulmonary arrest at prehospital or an AIS score of 6. Their characteristics, interventions, and outcomes were analyzed to compare REBOA and ACC. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to compare the outcomes between REBOA and ACC adjusting severity. One to one propensity score matching was also performed to compare them.
Results: 903 of the 159,157 trauma patients were eligible based on the selection criteria. Overall, 405/607 patients (67%) who had REBOA died compared to 210/233 patients (90%) who had ACC. Patients with REBOA had higher RTS (mean±SD; 5.2±2.0 vs. 4.2±2.2; P<0.001) but higher ISS (Median (interquartile); 34 (25) vs. 34 (20); P<0.001), higher probability of survival (0.43±0.36 vs. 0.27±0.30; P<0.001) compared to those with ACC. REBOA had an odds ratio (OR) for in-hospital mortality of 0.309 (95% CI, 0.190 to 0.502) adjusting for TRISS using a logistic regression model (n=903). Similar associations were observed (OR, 0.224; 95% CI, 0.129 to 0.700) adjusting for RTS or (OR, 0.188; 95% CI, 0.116 to 0.303) adjusting for ISS. In the propensity score-matched cohort (n=304), REBOA was associated with lower mortality compared to ACC (OR, 0.261; 95% CI, 0.130 to 0.523). Patients with REBOA had still less severe chest complications than those with ACC (AIS chest, 3.8±0.8 vs. 4.2±0.8; P<0.001) although physiological severity and backgrounds were similar in this population.
Conclusions: Patients who underwent aortic occlusion had a high mortality. REBOA may be one of favorable alternative methods to resuscitative ACC for severe torso trauma although some indication bias could still remain. Further studies needed to elucidate optimal indications.
Author Disclosures: T. Abe: Research Grant; Significant; Hitachi, Ltd.. M. Uchida: None. I. Nagata: None. D. Saitoh: None. N. Tamiya: None.
- © 2016 by American Heart Association, Inc.