B. Litmanovich1, O. Hejazi1, T. Anand1, M. Khurshid1, C. Stewart1, C. Colosimo1, A. Nelson1, L. Castanon1, L.J. Magnotti1, B. Joseph1 1University Of Arizona, Trauma, Critical Care, Burns & Emergency Surgery/ Department Of Surgery, Tucson, AZ, USA
Introduction: The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) in the resuscitation of hemorrhaging trauma patients remains unclear. The aim of our study was to compare the outcomes of patients who received REBOA in the operating room (OR) to those patients who underwent REBOA in the emergency department (ED) on a nationwide scale.
Methods: We performed a retrospective analysis of the ACS-TQIP 2017 – 2018. We included all adult trauma patients who underwent REBOA and hemorrhage control surgery. We excluded patients who had hemorrhage control surgery in the ED. We stratified patients based on the setting in which REBOA was performed into ED and OR groups. Outcome measures were 24-hour transfusions requirements, REBOA related complications, 24-hour mortality and in-hospital mortality. Descriptive statistics, Mann-Whitney U test, and chi square tests were performed.
Results:We identified a total of 514 patients who underwent REBOA (ED 36% vs OR 64%). The mean age was 43 (19) years, 73% were male, and 70% sustained blunt injuries with a median ISS of 26 [17 – 38] with no significant difference between the groups. The ED group had significantly lower median SBP on arrival compared to OR group (82 vs 100 mm Hg, p <0.001). The median time to REBOA was 41 [21 – 116] minutes. There was no difference in the median time to hemorrhage control surgery (ED 66 [41 – 124], OR 68 [38 – 128] mins, p = 0.09), 24-hour PRBC transfusions (17U vs 17U, p = 0.912), REBOA related complications (ED 14% vs OR 12.5%, p = 0.58), 24-hour mortality (ED 40% vs OR 36%, p = 0.34), and in-hospital mortality (ED 62% vs OR 55%, p = 0.11) between the two groups.
Conclusion:These findings suggest no difference in terms of transfusions, complications, and mortality based on the setting in which REBOA was performed. Future studies should determine the appropriate indication and setting for REBOA insertion to improve the outcomes of hemorrhaging trauma patients.