Article Text
Abstract
Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality.
Methods The American Association for the Surgery of Trauma AORTA registry was used to identify patients undergoing REBOA. Injury characteristics and outcomes data were compared between OR and ED groups. The primary outcome was in-hospital mortality; secondary outcomes included total AO time, transfusion requirements, and acute kidney injury.
Results Location and timing of catheter insertion were available for 305 of 321 (95%) subjects. 58 patients underwent REBOA in the OR (19%). There were no differences with respect to sex, admission lactate, and Injury Severity Score. The OR group was younger (33 years vs. 41 years, p=0.01) and with more penetrating injuries (36% vs. 15%, p<0.001). There were significant differences with respect to admission physiology. Time from admission to AO was longer in the OR group (75 minutes vs. 23 minutes, p<0.001) as was time to definitive hemostasis (116 minutes vs. 79 minutes, p=0.01). Unadjusted mortality was lower in the OR group (36.2% vs. 68.8%, p<0.001). There were no differences in secondary outcomes. After controlling for covariates, there was no association between insertion location and in-hospital mortality (OR 1.8, 95% CI 0.30 to 11.50).
Discussion OR REBOA placement is common and generally employed in patients with more stable admission physiology. OR placement was not associated with increased in-hospital mortality despite longer times to AO and definite hemostasis when compared with catheters placed in the ED.
Level of evidence IV; therapeutic/care management.
- resuscitation for Shock
- hemorrhagic shock
- emergency department thoracotomy
- endovascular procedures
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Footnotes
Presented at These data were presented in poster format at the 77th Annual Meeting of the American Association for the Surgery of Trauma, September 26–29, 2018 in San Diego, California.
Collaborators AAST AORTA Study Group: Jonny Morrison, MD, PhD; Thomas M. Scalea, MD University of Maryland / R Adams Cowley Shock Trauma Center Baltimore, MD, USA Laura J. Moore, MD, FACS; Jeanette M Podbielski, RN, CCRP; John B. Holcomb, MD; University of Texas Health Sciences Center– Houston Houston, TX, USA Kenji Inaba, MD; Alice Piccinini, MD Los Angeles County + University of Southern California Hospital Los Angeles, CA, USA David S. Kauvar, MD, FACS; Valorie L. Baggenstoss, MSN, RN; Catherine Rauschendorfer BSN, RN San Antonio Military Medical Center / US Army Institute of Surgical Research San Antonio, TX, USA Jeremey Cannon, MD; Mark Seamon, MD; Ryan Dumas, MD; Michael Vella, MD; Jessica Guzman University of Pennsylvania Philadelphia, PA, USA Chance Spalding, DO, PhD; Timothy W. Wolff, DO Ohio Health Columbus, Ohio, USA Chuck Fox, MD; Ernest Moore, MD Denver Health and Hospital Authority Denver, CO USA David Turay, MD; Cassra N. Arbabi, MD; Xian Luo-Owen, PhD Loma Linda University Medical Center Loma Linda, CA, USA David Skarupa, MD; Jennifer A. Mull, RN, CCRC; Joannis Baez Gonzalez University of Florida – Jacksonville Jacksonville, FL, USA Joseph Ibrahim, MD; Karen Safcsak RN, BSN Orlando Regional Medical Center Orlando, FL, USA Stephanie Gordy, MD; Michael Long, MD Ben Taub General Hospital / Baylor College of Medicine Houston, TX, USA Andrew W. Kirkpatrick, MD; Chad G. Ball, MD; Zhengwen Xiao, MD, MSc, PhD Foothills Medical Centre Calgary, Alberta, Canada Elizabeth Dauer, MD Temple University Philadelphia, PA, USA Jennifer Knight, MD; Nicole Cornell, BS, MS West Virginia University Hospitals Morgantown, WV, USA Forrest “Dell” Moore, MD John Peter Smith Hospital Fort Worth, TX, USA Matthew Bloom, MD Cedars Sinai Hospital Los Angeles, CA, USA Nam T. Tran, MD; Eileen Bulger, MD University of Washington – Harborview Seattle, WA, USA Jeannette G. Ward, MS-CR Chandler Regional Medical Center Chandler, AZ, USA John K. Bini, MD; John Matsuura, MD; Joshua Pringle, MD; Karen Herzing, BSN, RN; Kailey Nolan, BS Wright State Research Institute - Miami Valley Hospital Dayton, OH, USA Nathaniel Poulin, MD; Vidant Medical Center Greeneville, NC, USA William Teeter, MD University of North Carolina at Chapel Hill Chapel Hill, NC, USA Rachel Nygaard, PhD; Chad Richardson, MD; Joseph Skaja, MD; Derek Lombard, MD Hennepin Healthcare Minneapolis, MN, USA Reagan Bollig, MD; Brian Daley, MD; Niki Rasnake, BSN, RN, CEN University of Tennessee Medical Center Knoxville, TN, USA Marko Bukur, MD; Elizabeth Warnack, MD Bellevue Hospital /NYU New York, NY, USA Joseph Farhat, MD North Memorial Medical Center Minneapolis, MN, USA Robert M. Madayag, MD, FACS; Pamela Bourg, PhD, RN, TCRN, FAEN St. Anthony Hospital Lakewood, CO, USA.
Contributors All authors have made substantial contributions to this article, including conception and design of the study (MAV, RPD, JD, JWC), acquisition and analysis/interpretation of the data (MAV, RPD, JD, JM, TS, LM, JP, KI, AP, DSK, VLB, CS, CF, EEM, JWC), drafting of the article (MAV, RPD, JWC), and critical revisions (MAV, RPD, JD, JM, TS, LM, JP, KI, AP, DSK, VLB, CS, CF, EEM, JWC). All authors have reviewed and approved this final article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests The following conflicts of interest pertain to Prytime Medical Devices: University of Pennsylvania Simulation Center (REBOA simulation equipment); EEM (research support); JM (clinical advisory board); CF (medical consultant); and CS (unpaid speaker).
Patient consent for publication Not required.
Ethics approval This project was approved by the University of Pennsylvania Institutional Review Board and by each institutional review board at participating sites.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article.