J. A. Balch1, T. J. Loftus1, A. M. Mohr1, R. S. Smith1 1University of Florida, General Surgery, Gainesville, FL, USA
Introduction:
Emergency Department aortic occlusion using either resuscitative endovascular balloon occlusion of the aorta (REBOA) or resuscitative thoracotomy for trauma and hemorrhagic shock are poor, leading some to question the utility of these strategies. This report summarizes patient outcomes over a four-year period following REBOA vs resuscitative thoracotomy at a single, level 1 trauma center with hybrid room capabilities.
Methods:
This retrospective cohort analysis compared patients who underwent zone 1 aortic occlusion via resuscitative thoracotomy (n=13) vs. REBOA (n=13) for blunt or non-thoracic, penetrating trauma and refractory hemorrhagic shock (systolic blood pressure less than 90 mmHg despite volume resuscitation) at a level 1 trauma center with a dedicated, trauma hybrid operating room. The primary outcome was survival to hospital discharge. The secondary outcome was neurologic status at hospital discharge, assessed by Glasgow Coma Scale (GCS) scores. Variables were compared using non-parametric Kruskal-Wallis or Fischer Exact testing.
Results:
Overall median age was 40 years, 27% had penetrating injuries, and 23% had pre-hospital, closed-chest cardiopulmonary resuscitation. In both cohorts, median Injury Severity Scores and head Abbreviated Injury Scores were 26 and 2, respectively. The resuscitative thoracotomy cohort had lower systolic blood pressure on arrival (0 [0-75] vs. 76 [65-99], p=0.009). Hemorrhage control (systolic blood pressure 100 mmHg without ongoing vasopressor or transfusion requirements) was obtained in 77% of all REBOA cases and 8% of all resuscitative thoracotomy cases (p=0.001). Survival to hospital discharge was greater in the REBOA cohort (54% vs. 8%, p=0.030), as was discharge with GCS 15 (46% vs. 0%, p=0.015).
Conclusions:
Among patients undergoing aortic occlusion for blunt or non-thoracic, penetrating trauma and refractory hemorrhagic shock at a center with a dedicated, trauma hybrid operating room, nearly half of all patients managed with REBOA had neurologically intact survival. Patients undergoing resuscitative thoracotomy had greater severity of shock on arrival, thus limiting comparisons between the two modalities.
