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Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Severe Torso Trauma in Japan: A Descriptive Study

  • Shokei MatsumotoEmail author
  • Kei Hayashida
  • Taku Akashi
  • Kyoungwon Jung
  • Kazuhiko Sekine
  • Tomohiro Funabiki
  • Takashi Moriya
Original Scientific Report
  • 83 Downloads

Abstract

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has the potential to be an alternative to open aortic cross-clamping (ACC). However, its practical indication remains unknown. We examined the usage trend of REBOA and ACC in Japan for severe torso trauma and investigated whether these procedures were associated with the time of death distribution based on a large database from the Japan Trauma Data Bank (JTDB).

Methods

The JTDB from 2004 to 2014 was reviewed. Eligible patients were restricted to those with severe torso trauma, which was defined as an abbreviated injury scale score of ≥4. Patients were classified into groups according to the aortic occlusion procedures. The primary outcomes were the rates of REBOA and ACC use according to the clinical situation. We also evaluated whether the time of death distribution for the first 8 h differed based on these procedures.

Results

During the study period, a total of 21,533 patients met our inclusion criteria. Overall, REBOA was more commonly used than ACC for patients with severe torso trauma (2.8% vs 1.5%). However, ACC was more frequently used in cases of thoracic injury and cardiac arrest. Regarding the time of death distribution, the cumulative curve for death in REBOA cases was elevated much more slowly and mostly flat for the first 100 min.

Conclusions

REBOA is more commonly used compared to ACC for patients with severe torso trauma in Japan. Moreover, it appears that REBOA influences the time of death distribution in the hyperacute phase.

Notes

Author’s contribution

SM, TA, TF, and KJ participated in the study design. SM and KH participated in the analysis and interpretation of data. SM and KS participated in drafting the article. TM critically revised the manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare that there is no conflict of interest.

Supplementary material

268_2019_4968_MOESM1_ESM.pptx (171 kb)
Appendix 1. Algorithm for torso hemorrhage control. EDT, emergency department resuscitative thoracotomy. Reproduced with permission from Lippincott, Williams & Wilkins. Source: Biffl WL, Fox CJ, Moore EE. The role of REBOA in the control of exsanguinating torso hemorrhage. J Trauma Acute Care Surg. 2015;78(5):1054-8. (PPTX 171 kb)
268_2019_4968_MOESM2_ESM.pptx (42 kb)
Appendix 2. Trends in REBOA and ACC for severe torso trauma. ACC, open aortic cross-clamping; REBOA, resuscitative endovascular balloon occlusion of the aorta (PPTX 41 kb)
268_2019_4968_MOESM3_ESM.docx (23 kb)
Supplementary material 3 (DOCX 23 kb)
268_2019_4968_MOESM4_ESM.docx (24 kb)
Supplementary material 4 (DOCX 23 kb)
268_2019_4968_MOESM5_ESM.docx (21 kb)
Supplementary material 5 (DOCX 20 kb)
268_2019_4968_MOESM6_ESM.pptx (1.9 mb)
Appendix 6. A. Intra-aortic occlusion balloon (IABO), MERA Tokyo, Japan. The 10-Fr sheath and vascular puncture set. B. Rescue Balloon, Tokai Medical Products, Aichi, Japan. The 7-Fr sheath and vascular puncture set. (PPTX 1948 kb)

References

  1. 1.
    Biffl WL, Fox CJ, Moore EE (2015) The role of REBOA in the control of exsanguinating torso hemorrhage. J Trauma Acute Care Surg 78(5):1054–1058CrossRefPubMedGoogle Scholar
  2. 2.
    Pasley J, Cannon J, Glaser J, Polk T et al. (2017) Joint trauma system clinical practice guideline (JTS CPG), resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock (CPG ID: 38). http://prytimemedical.com/wp-content/uploads/2017/07/REBOA_-CPG_FINAL.pdf. Accessed 14 Dec 2018
  3. 3.
    Norii T, Crandall C, Terasaka Y (2015) Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients. J Trauma Acute Care Surg 78(4):721–728CrossRefPubMedGoogle Scholar
  4. 4.
    Inoue J, Shiraishi A, Yoshiyuki A et al (2016) Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma: a propensity score analysis. J Trauma Acute Care Surg 80(4):559–566 (discussion 66–67) CrossRefPubMedGoogle Scholar
  5. 5.
    Abe T, Uchida M, Nagata I et al (2016) Resuscitative endovascular balloon occlusion of the aorta versus aortic cross clamping among patients with critical trauma: a nationwide cohort study in Japan. Crit Care 20(1):400CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Aso S, Matsui H, Fushimi K et al (2017) Resuscitative endovascular balloon occlusion of the aorta or resuscitative thoracotomy with aortic clamping for noncompressible torso hemorrhage: a retrospective nationwide study. J Trauma Acute Care Surg 82(5):910–914CrossRefPubMedGoogle Scholar
  7. 7.
    Russo RM, Neff LP, Lamb CM et al (2016) Partial resuscitative endovascular balloon occlusion of the aorta in swine model of hemorrhagic shock. J Am Coll Surg 223(2):359–368CrossRefPubMedGoogle Scholar
  8. 8.
    Morrison JJ, Ross JD, Rt Houston et al (2014) Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage. Shock 41(2):130–137CrossRefPubMedGoogle Scholar
  9. 9.
    Scott DJ, Eliason JL, Villamaria C et al (2013) A novel fluoroscopy-free, resuscitative endovascular aortic balloon occlusion system in a model of hemorrhagic shock. J Trauma Acute Care Surg 75(1):122–128CrossRefPubMedGoogle Scholar
  10. 10.
    Markov NP, Percival TJ, Morrison JJ et al (2013) Physiologic tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock. Surgery 153(6):848–856CrossRefPubMedGoogle Scholar
  11. 11.
    White JM, Cannon JW, Stannard A et al (2011) Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Surgery 150(3):400–409CrossRefPubMedGoogle Scholar
  12. 12.
    Brenner M, Teeter W, Hoehn M et al (2018) Use of resuscitative endovascular balloon occlusion of the aorta for proximal aortic control in patients with severe hemorrhage and arrest. JAMA Surg 153(2):130–135CrossRefPubMedGoogle Scholar
  13. 13.
    Brenner M, Hoehn M, Pasley J et al (2014) Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg 77(2):286–291CrossRefPubMedGoogle Scholar
  14. 14.
    Rafieian-Kopaei M, Setorki M, Doudi M et al (2014) Atherosclerosis: process, indicators, risk factors and new hopes. Int J Prev Med 5(8):927–946PubMedPubMedCentralGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Shokei Matsumoto
    • 1
    • 2
    Email author
  • Kei Hayashida
    • 3
  • Taku Akashi
    • 1
  • Kyoungwon Jung
    • 4
  • Kazuhiko Sekine
    • 5
  • Tomohiro Funabiki
    • 1
  • Takashi Moriya
    • 2
  1. 1.Department of Trauma and Emergency SurgerySaiseikai Yokohamashi Tobu HospitalYokohama-ShiJapan
  2. 2.Department of Emergency and Critical Care Medicine, Saitama Medical CenterJichi Medical UniversitySaitama CityJapan
  3. 3.Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonUSA
  4. 4.Division of Trauma Surgery, Department of SurgeryAjou University School of MedicineSuwonSouth Korea
  5. 5.Department of Emergency MedicineSaiseikai Central HospitalTokyoJapan

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