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

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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.

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Authors and Affiliations

  1. Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama-Shi, Kanagawa, 230-0012, Japan

    Shokei Matsumoto, Taku Akashi & Tomohiro Funabiki

  2. Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan

    Shokei Matsumoto & Takashi Moriya

  3. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, USA

    Kei Hayashida

  4. Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea

    Kyoungwon Jung

  5. Department of Emergency Medicine, Saiseikai Central Hospital, Tokyo, Japan

    Kazuhiko Sekine

Authors
  1. Shokei Matsumoto
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  2. Kei Hayashida
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  3. Taku Akashi
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  4. Kyoungwon Jung
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  5. Kazuhiko Sekine
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  6. Tomohiro Funabiki
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  7. Takashi Moriya
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Contributions

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.

Corresponding author

Correspondence to Shokei Matsumoto.

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The authors declare that there is no conflict of interest.

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Electronic supplementary material

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268_2019_4968_MOESM1_ESM.pptx

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

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)

Supplementary material 3 (DOCX 23 kb)

Supplementary material 4 (DOCX 23 kb)

Supplementary material 5 (DOCX 20 kb)

268_2019_4968_MOESM6_ESM.pptx

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)

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Matsumoto, S., Hayashida, K., Akashi, T. et al. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Severe Torso Trauma in Japan: A Descriptive Study. World J Surg 43, 1700–1707 (2019). https://doi.org/10.1007/s00268-019-04968-2

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  • DOI: https://doi.org/10.1007/s00268-019-04968-2

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