Brenner M, et al. - Researchers performed this study to describe the largest single-institution experience with resuscitative endovascular balloon occlusion of the aorta (REBOA) in the United States. They recognized REBOA as a minimally invasive alternative to emergency department thoracotomy with aortic cross-clamp to temporize noncompressible torso hemorrhage and obtain proximal control in both traumatic and nontraumatic causes of hemorrhage. They identified the utility of REBOA for more targeted aortic occlusion (AO) in the distal aorta for pelvic, junctional, or extremity hemorrhage.

Methods

• From February 1, 2013, to January 31, 2017, researchers investigated the use of REBOA at an urban tertiary care facility for severe traumatic hemorrhage, traumatic arrest (AR), or nontraumatic hemorrhage (NTH) among 90 patients who were not responsive or were transiently responsive to resuscitation measures, or were in arrest, from presumed hemorrhage below the diaphragm.
• Trauma or nontrauma-related hemorrhage was the possible cause.
• They excluded patients with ruptured aortic aneurysms.
• In-hospital mortality was assessed.

Results

• This study included 90 patients (15 women and 75 men; mean [SD] age, 41.5 [17.4] years); 29 underwent REBOA for severe traumatic hemorrhage, 50 for AR, and 11 for NTH.
• The median age of patients with severe traumatic hemorrhage and AR was 36.2 years (interquartile range, 25.3-55.5 years), mean (SD) admission Glasgow Coma Scale score was 6 (5), and median Injury Severity Score was 39 (interquartile range, 10-75).
• Occlusion of distal thoracic aorta was evident in 73 patients (81%), and in all patients with AR.
• Distal abdominal AO was observed in 17 patients (19%).
• In patients with severe traumatic hemorrhage, mean (SD) systolic blood pressure improved, from 68 (28) mm Hg prior to AO, to 131 (12) mm Hg after AO (P<.001).
• In this study, percutaneous access was utilized in 30 patients (33%), including 13 patients with AR (26%), and groin cutdown in 60 patients (67%), including 37 patients with AR (74%).
• Findings revealed an overall 30-day mortality of 62% (n=56): 11 (39%) in patients with severe traumatic hemorrhage and 45 (90%) in patients with AR.
• Of the patients with AR, 29 (58%) had return of spontaneous circulation and 11 of those patients (38%) survived to the operating room.
• Full neurologic recovery was observed in all patients who survived AR.
• From REBOA use, no aortoiliac injury or limb loss occurred.
• REBOA was performed on 11 for NTH; 7 (64%) were in arrest.
• For patients with NTH, overall in-hospital mortality of 36% (n=4) was evident.
• This groups indicated no procedural complications.