Partial REBOA Zone 1 is associated with lower mortality compared to complete REBOA Zone 1 and emergency department thoracotomy: A cohort study using the AORTA registry.

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) and emergency department thoracotomy (EDT) are effective methods of aortic occlusion (AO) for life-threatening bleeding; however, complete AO can lead to visceral ischemia. Partial REBOA (P-REBOA) has been proposed as an alternative to the completely occlusive REBOA (C-REBOA) to balance hemorrhage control and perfusion. Using the Aortic Occlusion for Resuscitation in Trauma (AORTA) multicenter, observational registry, we tested the hypothesis that P-REBOA resulted in better outcomes compared to EDT and C-REBOA.

Study design and methods: We queried the 2017-2023 AORTA registry for adults who underwent EDT, C-REBOA, or P-REBOA in the emergency department (ED). Patients with chest penetrating injuries were excluded. We compared mortality, ventilator-free-days (VFD), and ICU-free-days (ICUFD) using survival analysis or generalized linear models to adjust for confounders.

Results: Overall, 921 patients underwent EDT (n = 613, 66.6%), C-REBOA (n = 224, 24.3%), or P-REBOA (n = 84, 9.1%); 83.1% died. After confounder adjustment, compared to P-REBOA, both C-REBOA and EDT were associated with a lower likelihood of attaining hemodynamic improvement and stability as well as with higher mortality (adjusted hazard ratio, aHR = 1.84; 95% CI: 1.01-1.60 and aHR = 3.32; 95% CI: 1.96-2.78, respectively). EDT patients had less VFD and ICUFD than those undergoing C-REBOA and P-REBOA, but there were no differences between the two endovascular procedures. Among patients who survived >48 h, EDT was more likely to be associated with complications compared to the other two procedures.

Discussion: P-REBOA was more likely to be associated with improved hemodynamic stability and reduced mortality compared to C-REBOA and EDT, suggesting this modality may be a better AO procedure for patients with no penetrating thoracic injuries.