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Association of resuscitative endovascular balloon occlusion of the aorta (REBOA) and mortality in penetrating trauma patients

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Abstract

Purpose

The purpose of this study was to examine the association of REBOA and mortality in a group of patients with penetrating trauma to the torso, treated in a level-I trauma center from Colombia.

Methods

In a retrospective cohort study, patients with penetrating trauma, requiring emergency surgery, and treated between 2014 and 2018, were included. The decision to use or not use REBOA during emergent surgery was based on individual surgeon’s opinion. A propensity score (PS) was calculated after adjusting for age, clinical signs on admission (systolic blood pressure, cardiac rate, Glasgow coma scale), severe trauma in thorax and abdomen, and the presence of non-compressive torso hemorrhage. Subsequently, logistic regression for mortality was adjusted for the number of red blood cells (RBC) transfused within the first six hours after admission, injury severity score (ISS), and quintiles of PS.

Results

We included 345 patients; 28 of them (8.1%) were treated with REBOA. Crude mortality rates were 17.9% (5 patients) in REBOA group and 15.3% (48 patients) in control group (p = 0.7). After controlling for RBC transfused, ISS, and the PS, the odds of death in REBOA group was 78% lower than that in the control group (odds ratio [OR] 0.20, 95% confidence interval [95%CI] 0.05–0.77, p = 0.01).

Conclusion

We found that, when compared to no REBOA use, patients treated with REBOA had lower risk-adjusted odds of mortality. These findings should be interpreted with caution and confirmed in future comparative studies, if possible.

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Acknowledgements

This paper was presented at the 2018 4th Trauma Congress in San Diego, California.

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Authors and Affiliations

  1. Fundacion Valle del Lili University Hospital, Clinical Research Center, Cali, Colombia

    Alberto F. García, Ramiro Manzano-Nunez, Álvaro I. Sánchez & Carlos A. Ordoñez

  2. Department of Surgery, Universidad del Valle, Cali, Colombia

    Alberto F. García, Juan Melendez & Carlos A. Ordoñez

  3. School of Medicine, Universidad ICESI, Cali, Colombia

    Alberto F. García, Juan Ruiz-Yucuma, Alejandra Londoño, Camilo Salazar & Carlos A. Ordoñez

  4. Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia

    Ramiro Manzano-Nunez

  5. Brigham and Women’s Hospital, Department of Surgery, Center for Surgery and Public Health, Boston, MA, USA

    Claudia P. Orlas

  6. Department of Surgery, University of Pittsburg, Pittsburgh, PA, USA

    Juan Carlos Puyana

Authors
  1. Alberto F. García
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  2. Ramiro Manzano-Nunez
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  4. Juan Ruiz-Yucuma
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  6. Camilo Salazar
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  7. Juan Melendez
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  8. Álvaro I. Sánchez
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  9. Juan Carlos Puyana
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  10. Carlos A. Ordoñez
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Corresponding author

Correspondence to Ramiro Manzano-Nunez.

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The authors declare that they have no conflict of interest.

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Research Involving human participants

Although this is a retrospective study, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board (Fundacion Valle del Lili IRB) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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García, A.F., Manzano-Nunez, R., Orlas, C.P. et al. Association of resuscitative endovascular balloon occlusion of the aorta (REBOA) and mortality in penetrating trauma patients. Eur J Trauma Emerg Surg 47, 1779–1785 (2021). https://doi.org/10.1007/s00068-020-01370-9

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  • DOI: https://doi.org/10.1007/s00068-020-01370-9

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