M. Plunkett1, A. Shridhar1, J. Duchesne2, J. Hunt1, A. Marr1, L. Stuke1, P. Greiffenstein1, J. Schoen1, A. Smith1 1Louisiana State University Health Sciences Center, New Orleans, LA, USA 2Tulane University School Of Medicine, New Orleans, LA, USA
Introduction: Trauma patients with obesity present significant anatomic and physiologic challenges. There is a paucity of evidence examining the impact of obesity on methods of aortic occlusion (AO). The objective of this study was to investigate outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with and without obesity.
Methods: A retrospective chart review of adult blunt trauma patients who underwent REBOA placement from the American Association for the Surgery of Trauma (AAST) Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) database was performed over a 10-year period. Blunt mechanisms of injury include falls, motor vehicle accidents, motorcycle accidents, and auto vs. pedestrian accidents. Patients were stratified by BMI<30 (LBMI) versus BMI≥30 (HBMI). Chi-squared tests were used to analyze categorical variables, and continuous variables were analyzed using Mann-Whitney non-parametric t-tests. Statistical significance was set at p<0.05.
Results: A total of 502 patients were separated into two groups: LBMI (n=302) and HBMI (n=200). There were no significant differences between groups for abbreviated injury scale, injury severity score, and initial HR and SBP (p>0.05). When comparing outcomes of initial AO, there was no significant difference in the incidence of in-hospital mortality (p=0.80) or success in achieving hemodynamic stability (p=0.77). There was no significant difference in access site complications between the two groups (p>0.05). However, there was a significant difference in time from admission to hemodynamic stability with HBMI having a median of 39.5 minutes (IQR 25.0-89.8) and LBMI having a median of 33.0 minutes (IQR 23.0-56.5) (p=0.034). Acute kidney injuries occurred more commonly in patients with HBMI at 33.5% versus 22.5% in LBMI patients (p=0.007). No significant differences were found when analyzing pREBOA versus ER-REBOA.
Conclusion: REBOA placement is becoming a treatment alternative to resuscitative thoracotomy. Following REBOA placement, there was an increase in time from admission to hemodynamic stability and AKI occurrence in patients with obesity. Future studies are needed to further define this observation and possible strategies to mitigate it.