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Resuscitative Endovascular Balloon Occlusion of the Aorta is Associated with Increased Risk of Extremity Compartment Syndrome

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Abstract

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a temporizing procedure to control intra-abdominal or pelvic bleeding. Theoretically, occlusion of the aorta and the resulting ischemia–reperfusion of the lower extremities may increase the risk of extremity compartment syndrome (CS). To date, no study has addressed systematically the incidence and risk factors of CS following REBOA intervention. The purpose of this study was to address this knowledge gap.

Methods

Adult trauma patients from the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2016–2019) were included. Patients who received REBOA within 4 h of admission were compared to patients without REBOA after propensity score matching for demographics, vital signs on admission, comorbidities, injury severity of different body regions, pelvic and lower extremity fractures, vascular trauma to the lower extremities, fixation for fractures, angioembolization (AE) for pelvis, preperitoneal pelvic packing (PPP), laparotomy, and venous thromboembolism (VTE) prophylaxis. The primary outcomes were rates of lower extremity CS and fasciotomy and acute kidney injury (AKI). Secondary outcomes included mortality.

Results

There were 534 patients who received REBOA matched with 1043 patients without REBOA. Overall, patients in the REBOA group had significantly higher rates of CS than no REBOA patients [5.4% vs 1.1%, p < 0.001, OR: 5.39]. The risk of CS remained significantly higher in the subgroups of patients with or without pelvic or lower extremity fractures, as well as in the subgroup of patients with associated extremity vascular injury [11.2% vs 1.5%, p < 0.001, OR: 8.12].The fasciotomy and AKI rates were significantly higher in the REBOA group (5.8% vs 1.2%, p < 0.001 and 12.9% vs 7.4%, p< 0.001 respectively).

Conclusion

REBOA use is associated with a higher risk of lower extremity CS, fasciotomy and AKI, especially in patients with associated lower extremity vascular injuries. These complications should be taken into account when considering REBOA use, and close observation for this complication should always be part of the routine monitoring.

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Authors and Affiliations

  1. Division of Trauma, Emergency Surgery, Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo St, Los Angeles, CA, 90033, USA

    Yu-Tung Wu, Meghan R. Lewis, Miharu Arase & Demetrios Demetriades

  2. Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

    Yu-Tung Wu

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  1. Yu-Tung Wu
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  2. Meghan R. Lewis
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Correspondence to Demetrios Demetriades.

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The study has been approved by the Institutional Review Board at University of Southern California Institutional Review Board (HS-22-00465).

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Wu, YT., Lewis, M.R., Arase, M. et al. Resuscitative Endovascular Balloon Occlusion of the Aorta is Associated with Increased Risk of Extremity Compartment Syndrome. World J Surg 47, 796–802 (2023). https://doi.org/10.1007/s00268-022-06832-2

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  • DOI: https://doi.org/10.1007/s00268-022-06832-2

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