Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) After Traumatic Brain Injury

Abstract

Background: The effects of resuscitative endovascular balloon occlusion of the aorta (REBOA) on progression oftraumatic brain injury (TBI) are unclear. Two hypotheses prevail: increased mean arterial pressure may improve cerebralperfusion, or cause cerebral edema due to elevated intracranial pressure. This study compares outcomes inhypotensive, blunt trauma patients with TBI treated with and without REBOA.Methods: A retrospective analysis compared hypotensive (systolic blood pressure [SBP] >90) blunt trauma patientswith TBI treated with REBOA to those treated without. Patients with spontaneous circulation at admission and atinitiation of aortic occlusion were included. Patients requiring cardiopulmonary resuscitation in the emergencydepartment (ED) were excluded. Radius matching used age, injury severity score (ISS), abbreviated injury score (AIS)-head, and Glasgow coma score (GCS) and SBP at ED arrival.Results: Of 232 patients, 135 were treated with REBOA and 97 without. REBOA patients were older and had higherISS, AIS-head, AIS-chest and AIS-extremity. There was no difference in TBI severity, and mortality. In the matchedanalysis (n = 76 REBOA, n = 54 non-REBOA), there was no difference in ISS, AIS-head, pre-hospital, ED, or dischargeGCS, ED SBP, or mortality. Despite longer hospital stays for REBOA patients, there was no difference in intensive careunit length of stay, rate of discharge home, or discharge GCS.Conclusions: REBOA was used in more severely injured patients, but was not associated with higher mortality rate.REBOA should be considered for use in patients with non-compressible torso hemorrhage and concomitant TBI, as itdid not increase mortality, and outcomes were similar to non-REBOA patients.