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Comparison of clinical and anatomical criteria for resuscitative endovascular balloon occlusion of the aorta (REBOA) among major trauma patients in Nova Scotia

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Abstract

Objectives

To perform a province-wide evaluation of adult major traumas and determine the proportion of patients who met clinical and/or anatomical criteria for resuscitative endovascular balloon occlusion of the aorta (REBOA).

Methods

This is a retrospective analysis of all major trauma patients (age > 16) presenting to the sole adult level 1 trauma centre in Nova Scotia over a 5-year period (2012–2017). Data were collected from the Nova Scotia Trauma Registry and medical charts. We identified potential REBOA candidates using either: (1) clinical criteria (primary survey, Focused Assessment with Sonography for Trauma, pelvic/chest X-ray); or (2) anatomical criteria (ICD-10-CA codes). Potential candidates with persistent hypotension were considered true REBOA candidates.

Results

Overall 2885 patients were included in the analysis, of whom 248 (8.6%) patients were in shock (including 106 transfer patients) and had their charts reviewed. A total of 137 patients met clinical criteria for REBOA; 44 (1.5%) had persistent hypotension 10–20 min into resuscitation and were considered true REBOA candidates. There were 59 patients who met anatomical criteria for REBOA, of whom 15 (0.5%) patients had persistent hypotension and were true REBOA candidates. The 15 REBOA candidates based on anatomical criteria also met clinical criteria for REBOA.

Conclusions

In this registry-based retrospective analysis, 1.5% of adult major trauma patients Nova Scotia were REBOA candidates based on resuscitative clinical presentation, while 0.5% were candidates based on post hoc anatomical injury patterns. Our findings suggest that using clinical findings and bedside imaging modalities as criteria may overestimate the number of candidates for REBOA.

Résumé

Objectifs

Effectuer une évaluation à l'échelle de la province des traumatismes majeurs chez l'adulte et déterminer la proportion de patients qui répondaient aux critères cliniques et/ou anatomiques de l’occlusion endovasculaire par ballonnet de réanimation de l'aorte (REBOA).

Les méthodes

Analyse rétrospective de tous les patients ayant subi un traumatisme majeur (âge > 16 ans) qui se sont présentés au seul centre de traumatologie de niveau 1 pour adultes en Nouvelle-Écosse sur une période de 5 ans (2012-2017). Les données ont été recueillies à partir du registre des traumatismes de la Nouvelle-Écosse et des dossiers médicaux. Nous avons identifié des candidats potentiels à la REBOA en utilisant l'un ou l'autre : 1) des critères cliniques (enquête primaire, évaluation ciblée avec échographie pour les traumatismes, radiographie pelvienne/du thorax) ; ou 2) des critères anatomiques (codes CIM-10-CA). Les candidats potentiels présentant une hypotension persistante étaient considérés comme de véritables candidats au REBOA.

Résultats

Au total, 2 885 patients ont été inclus dans l'analyse, dont 248 (8,6 %) étaient en état de choc (dont 106 patients transférés) et ont vu leur dossier révisé. Au total, 137 patients répondaient aux critères cliniques pour la REBOA ; 44 (1,5 %) présentaient une hypotension persistante de 10 à 20 minutes en réanimation et étaient considérés comme de véritables candidats à la REBOA. Il y avait 59 patients qui répondaient aux critères anatomiques pour le REBOA, dont 15 (0,5 %) avaient une hypotension persistante et étaient de véritables candidats au REBOA. Les 15 candidats REBOA basés sur des critères anatomiques répondaient également aux critères cliniques de REBOA.

Conclusions

Dans cette analyse rétrospective basée sur un registre, 1,5 % des patients adultes ayant subi un traumatisme majeur en Nouvelle-Écosse étaient des candidats au REBOA sur la base d'une présentation clinique de réanimation, tandis que 0,5 % étaient des candidats sur la base de modèles de blessures anatomiques post-hoc. Nos conclusions suggèrent que l'utilisation des résultats cliniques et des modalités d'imagerie au chevet du patient comme critères peut surestimer le nombre de candidats à la REBOA.

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Acknowledgements

The authors thank Karen Ssebazza (Registry Coordinator, TNS) and David Urquhart (IT Manager, Department of Emergency Medicine, Dalhousie University) for assisting with data collection. Data used in this research were made available by the Nova Scotia Department of Health and Wellness. Any opinions expressed by the authors do not necessarily reflect the opinion of the Nova Scotia Department of Health and Wellness or TNS.

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Emergency Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada

    Sean Hurley & Robert S. Green

  2. Trauma Nova Scotia, Nova Scotia Health Authority, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada

    Mete Erdogan & Robert S. Green

  3. Division of Neurosurgery, Department of Surgery, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada

    Nelofar Kureshi

  4. Division of Vascular Surgery, Department of Surgery, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada

    Patrick Casey & Matthew Smith

  5. Department of Critical Care, Dalhousie University, Halifax, NS, B3H 4R2, Canada

    Robert S. Green

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Correspondence to Robert S. Green.

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Hurley, S., Erdogan, M., Kureshi, N. et al. Comparison of clinical and anatomical criteria for resuscitative endovascular balloon occlusion of the aorta (REBOA) among major trauma patients in Nova Scotia. Can J Emerg Med 23, 528–536 (2021). https://doi.org/10.1007/s43678-021-00100-3

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