Outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in severely injured adult trauma patients with isolated thoracic or abdominal trauma in Hemorrhagic shock

Background

There is conflicting literature regarding mortality outcomes associated with REBOA usage in patients with severe thoracic or abdominal trauma. Our study aims to assess the benefits and negative implications of REBOA use in adult trauma patients in hemorrhagic shock with severe thoracic or abdominal injuries.

Methods

This retrospective cohort analysis utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) database from 2017 to 2023 to evaluate adult patients with severe isolated thoracic or abdominal trauma undergoing REBOA placement. Patients were stratified by REBOA zone, type of injury, and trauma center level. Primary outcomes included Emergency Department (ED) and 24-h mortality. Secondary outcomes included time to hemorrhage control, transfusion volumes, and complications.

Results

In severely injured adult trauma patients with thoracic or abdominal injuries, REBOA was significantly associated with increased mortality (aOR: 15.456, 95 % CI: 3.340–71.516, p < 0.001), 4-h transfusion requirements (β = 3177.081, 95 % CI: 59.315–6294.848, p = 0.046), and 24-h transfusion requirements (β = 2750.609, 95 % CI: 704.078–4797.141, p = 0.008) in both blunt and penetrating injuries. Patients who underwent REBOA at level II trauma centers had greater odds of 24-h mortality. No significant differences were observed in time to hemorrhage control or complication rates.

Conclusion

REBOA use in adult trauma patients with severe thoracic or abdominal trauma consistently led to increased mortality and blood transfusion requirements even when outcomes were stratified by REBOA zone placement and trauma center level. REBOA use should be cautiously considered on a case-by-case basis in severely injured patients.