1Waseem Wahood,1Harmandip Singh, 1Jacqueline Mirza, 1Aaiz Hussain, 1Stephen Ely, 2Michael Renda
1Dr. Kiran C. Patel College of Allopathic Medicine, 2Kendall Regional Medical Center
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive technique used to control noncompressible torso hemorrhage (NCTH) in patients experiencing profound shock. REBOA primarily serves as a temporary course of action to bridge patients into a surgical intervention. Traditionally, the common approach to life-threatening hemorrhage has involved resuscitative thoracotomy (RT) with aortic cross-clamping. Our study compares REBOA with RT by evaluating peri- and post-procedural outcomes in patients whom have not lost vital signs nor sustained cardiac arrest.
Material(s) and Method(s):
The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) was utilized to extract procedure data in 2017. Patients who underwent REBOA (n = 83) were compared with patients who underwent RT (n = 114). Cox proportional hazard analysis was conducted comparing survival in the ICU between the two procedures. Kaplan-Meier curve was created to depict survival time. Multivariable logistic regression was conducted to compare complications between the two procedural techniques. Patients in cardiac arrest prior to arrival were excluded.
.Those who underwent REBOA had higher proportion of acute kidney injury complications compared to RT [8 (9.64%) vs. 1 (0.88%); p=0.004] as well as pulmonary embolism [5 (6.02%) vs. 0 (0.00%); p=0.008]. However, multivariable cox proportional hazard analysis indicated that inpatient mortality was less likely in the REBOA cohort compared to RT (HR: 0.49, p=0.049). REBOA patients had a higher average survival time in the ICU compared to RT patients (41.4 vs. 14.9 days, respectively; p=0.021). REBOA was found to have higher odds of acute kidney injury compared to RT (OR: 11.52; p<0.023).
Patients who underwent REBOA had a higher rate of survival in the ICU as compared with RT. However, REBOA was associated with more postprocedural complications compared to RT. We recommend further research on the efficacy and safety of REBOA.