Short Attention Span Summary
Using a trauma registry, REBOA was comparable (trending toward more favorable) to open aortic occlusion. We have not started using REBOA at our facility yet. I’m curious how many are using it at their institutions. Take the poll, immediately see the results, and find out what your colleagues are doing.
- Heft EMCast
J Trauma Acute Care Surg. 2016 Apr 5. [Epub ahead of print]
The AAST Prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) Registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA).
1From the David Grant Medical Center (J.J.D.), University of California-Davis, Davis, California; Department of Surgery (T.M.S., M.B.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland; Los Angeles County + University of Southern California Hospital (D.S., K.I.), Los Angeles, California; San Antonio Military Medical Center (J.C.), United States Army Institute of Surgical Research, San Antonio, Texas; University of Texas Health Sciences Center- Houston (L.M., J.H.), Houston, Texas; Loma Linda University Medical Center (D.T., C.N.A.), Loma Linda, California; University of Calgary (A.K., J.X.), Calgary, Alberta, Canada; University of Florida – Jacksonville (D.S.), Jacksonville, Florida; and East Carolina Medical Center (N.P.), New Bern, North Carolina.
Aortic occlusion (AO) for resuscitation in traumatic shock remains controversial. Resuscitative Endovascular Balloon Occlusion of the aorta (REBOA) offers an emerging alternative.
The AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry prospectively identified trauma patients requiring AO from 8 ACS level I centers. Presentation, intervention and outcome variables were collected and analyzed to compare REBOA and open AO.
From Nov 2013-Feb2015, 114 AO patients were captured (46 REBOA; 68 Open); 80.7% male; 62.3% blunt injured. AO occurred in the Emergency Department (ED) (73.7%) or Operating Room (OR) (26.3%). Hemodynamic improvement after AO was observed in 62.3% [REBOA 29/67.4%; Open 42/61.8%); 36.0% achieving stability (SBP consistently > 90 mm Hg, > 5 minutes) [REBOA 22/46; 47.8%; Open 19/68; 27.9%, p =0.014]. REBOA access was femoral cut-down (50%); US guided (10.9%) and percutaneous without imaging (28.3%). Deployment was achieved in zones I (78.6%), II (2.4%) and III (19.0%). A second AO attempt was required in 9.6% [REBOA 2/46, 4.3%; Open 9/68, 13.2%]. REBOA complications were uncommon (pseudoaneursym 2.1%; embolism 4.3%, 0% limb ischemia). There was no difference in time to successful AO between REBOA and open procedures [REBOA 6.6 ± 5.6 mins; Open 7.2 ± 15.1, p = 0.842]. Overall survival was 21.1% (24/114), with no significant difference between REBOA and open AO with regards to mortality [REBOA 28.2% (13/46); Open 16.1% (11/68); p = 0.120].
REBOA has emerged as a viable alternative to open AO in centers that have developed this capability. Further maturation of the AAST AORTA database is required to better elucidate optimal indications and outcomes.
LEVEL OF EVIDENCE:
Therapeutic / Care management, level IV.
PMID: 27050883 [PubMed – as supplied by publisher]