L. Epstein1, A. Grigorian2, K. Matsushima1, J. Nahmias2, J. Dilday1, D. Demetriades1 1University Of Southern California, Division Of Trauma, Emergency Surgery, And Surgical Critical Care, Los Angeles, CA, USA 2University Of California – Irvine, Division Of Trauma, Burns, Critical Care, & Acute Care Surgery, Orange, CA, USA
Introduction:
There are two accepted zones for the placement of a Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheter in trauma patients, either above the mesenteric vessels (Zone-1) or below the renal arteries (Zone-3). Zone-1 REBOA diverts more blood away from the lower body including the visceral organs which can lead to a significant systemic inflammatory response and reperfusion injury. As such, we hypothesized that patients undergoing Zone-1 placement of a REBOA had a higher risk of mortality compared to Zone-3 placement of a REBOA.
Methods:
The 2017-2019 Trauma Quality Improvement Program database was queried for patients undergoing either Zone-1 or Zone-3 REBOA. We excluded all patients with pre-hospital cardiac arrest. We compared Zone-1 versus Zone-3 REBOA using a 1:2 propensity-score model, matching for age, mechanism, sex, hypotension on admission (Systolic Blood Pressure <70 mmHg), tachycardia (>120 beats/min) on admission, blunt solid organ injury grade, pelvic fracture, and injuries to the aorta, iliac artery, iliac vein, and inferior vena cava.
Results:
We matched 130 Zone-1 REBOA patients to 260 Zone-3 REBOA patients. There were no statistically significant differences in the matched variables (all p>0.05). Compared to Zone-3 REBOA, patients with Zone-1 REBOA that survived >48-hours had similar rates of acute kidney injury (AKI) (18.6% vs. 10.9%, p=0.19) and sepsis (9.3% vs. 7.8%, p=0.75). Zone-1 REBOA patients had an overall higher mortality rate (71.4% vs. 48.8%, p=0.002) and mortality risk (OR 1.85, OR 1.18-2.89, p=0.007). Zone-1 REBOA also was associated with a higher risk of mortality after controlling for traumatic brain injury and injury severity score (OR 1.86, OR 1.18-2.92, p=0.007).
Conclusion:
Compared to Zone-3, using a REBOA in Zone-1 is associated with a higher risk of mortality. The higher risk of mortality for Zone-1 REBOA may be related to a severe systemic inflammatory response and reperfusion injury. We recommend using Zone-1 REBOA with caution.
