B. Shah1, E. Rady1, U. Pandya1, J. Hill1, M. Radomski1 1Ohiohealth Grant Medical Center, Department Of Trauma Surgery, Columbus, OH, USA
Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct for hemorrhage control in trauma. Many patients requiring aortic occlusion also have concomitant traumatic brain injury (TBI). The combination of TBI and hemorrhagic shock is highly lethal. Aortic occlusion can increase MAP, thus augmenting Cerebral Perfusion Pressure in TBI patients. Hypotension, and supraphysiologic hypertension can potentiate secondary insults in TBI. Endovascular aortic occlusion (EAO) can be done with full occlusion (FO), or partial occlusion (PO). PO allows for the titration of blood pressure whereas FO can only have a binary effect on blood pressure. There is a paucity of data on the effects of FO and PO in patients with TBI. Therefore, we aim to compare the effects of these two modalities in TBI patients.
Methods: This was a secondary retrospective analysis of the AAST AORTA registry that included all blunt trauma patients with AIS Head ≥1 and underwent EAO. We define severe TBI as Head AIS >4. We compared FO and PO. Primary outcomes were systolic blood pressure (SBP) goal after EAO and mortality. Patients were considered to have SBP at goal if it was between >90 and <140 mmHg within five minutes after EAO. Secondary outcomes were Length of Stay (LOS), discharge Glasgow Coma Scale (GCS), discharge Glasgow Outcome Scale (GOS), disposition, rates of craniectomy, and complications.
Results: 147 patients were included in the final analysis. Of these, 97 underwent FO and 50 underwent PO. Demographics for all TBI patients undergoing EAO were: age (40±18), sex (32% F), mechanism of injury (93% blunt), ISS (42±15), admission SBP (74±46 mmHg), admission GCS (6±4). There was no significant difference in demographics between the two groups. Patients undergoing PO had significantly decreased transfusion of platelets (5.3 vs 2.5, p=0.04), and administration of crystalloids (4 vs 1.5, p = 0.003). Patients with severe TBI that underwent PO met SBP goal significantly more often than patients who underwent FO (57.1 vs. 83, p = 0.019). Higher rates of ARDS were seen in patients that underwent FO regardless of TBI severity. There was no significant difference in LOS, mortality, discharge GCS, or discharge GOS, disposition or rates of craniectomy between EAO groups.
Conclusion: PO enables better SBP titration and thereby can minimize secondary insult in TBI. PO is associated with lower rates of ARDS. EAO type, however, is not associated with differences in survival in TBI patients.