Journal of the American College of Surgeons
Journal of the American College of Surgeons
5 years ago

Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry

Aortic occlusion (AO) is a potentially valuable tool for early resuscitation in patients nearing extremis or in arrest from severe hemorrhage. Study Design AAST AORTA registry identified trauma patients without penetrating thoracic injury undergoing AO at the level of the descending thoracic aorta (RT or Zone 1 REBOA) in the Emergency Department (ED). Survival outcomes relative to the timing of CPR need and admission hemodynamic status were examined. Results 285 patients were included: 81.8% male with injury due to penetrating mechanisms in 41.4%; median age 35.0 [IQR 29] and median ISS of 34.0 (IQR 18). EDT was utilized in 71%, and Zone 1 REBOA in 29%. Overall survival beyond the ED was 50% [RT 44%, REBOA 63%, p = 0.004] and survival to discharge was 5% [RT 2.5%, REBOA 9.6%, p = 0.023]. Discharge GCS was 15 in 85% of survivors. Pre-hospital CPR was required in 60% of patients with a survival beyond the ED of 37%, and survival to discharge of 3% (all p>0.05). Patients who did not require any CPR prior to had a survival beyond the ED of 70% [RT 48, REBOA 93%, p < 0.001] and survival to discharge of 13% (RT 3.4%, REBOA 22.2%, p = 0.048]. If AO patients did not require CPR, but presented with hypotension (SBP < 90 mm Hg; 9%; 65% RT; 35% REBOA), they achieved survival beyond the ED in 65% [p = 0.009] and survival to discharge of 15% [RT 0%, REBOA 44%, p = 0.008]. Conclusion Overall, REBOA may confer a survival benefit over RT, particularly in patients not requiring CPR. Significant further study is required to definitively recommend REBOA for specific subsets of injured patients.

Publisher URL: www.sciencedirect.com/science

DOI: S107275151830098X

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