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J Trauma Acute Care Surg. 2018 Jun 12. doi: 10.1097/TA.0000000000002004. [Epub ahead of print]

Early arterial access for REBOA is related to survival outcome in trauma.

Author information

1
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine.
2
Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine.
3
Department of Radiology, Teikyo University School of Medicine.
4
Senshu Trauma and Critical Care Center, Rinku General Medical Center.
5
Emergency and Critical Care Center, Ohta Nishinouchi Hospital.
6
Department of Emergency Medicine, Kyoto Second Red Cross Hospital.
7
Emergency and Critical Care Center, Hachinohe City Hospital.
8
Tajima Emergency & Critical Care Medical Center, Toyo-oka Hospital.
9
Department of Acute Medicine and Critical Care Medical Center, National Hospital Organization Osaka National Hospital.
10
Department of Emergency and Critical Care Center, Toho University Omori Medical Center.
11
Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital.

Abstract

INTRODUCTION:

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been employed in refractory hemorrhagic shock patients. Since the optimal timing of arterial access remains unclear, we evaluated the pre-occlusion status of patients and elapsed time from the arrival to the hospital are associated with the survival outcomes in the REBOA patients.

METHODS:

From August 2011-December 2016, The DIRECT-IABO investigators registered refractory hemorrhagic shock patients undergoing REBOA from 23 hospitals in Japan. Patient characteristics, mechanism of injury, injury severity score (ISS), pre- and post-occlusion systolic blood pressure (SBP), duration of aortic occlusion, clinical time course, and survival outcome were recorded and analyzed. Binary logistic regression analysis was used with mortality and Kaplan-Meier survival analysis was conducted to demonstrate the difference between early and delayed access groups.

RESULTS:

Among the enrolled 207 cases, the following patients were excluded from the analysis: five since they were <18 years of age, nine due to failed attempts at REBOA, 51 non-trauma patients and 33 who received resuscitative thoracotomy (RT) plus REBOA. Thus, the remaining 109 cases were analyzed (thirty day survivors, n=60; non-survivors, n=49). The pre-occlusion SBP was higher, and both hospital arrival to initial arterial access and duration of occlusion were shorter in the survivors. Lower ISS (OR, 0.944; 95% CI, 0.907-0.982; P=0.0039) and shorter arrival to access (OR, 0.989; 95% CI, 0.979-0.999; P=0.034) were significantly associated with 30-day survival in the logistic regression analysis. The cutoff point of 21.5 min was used in the receiver operating characteristic analysis. The early access group showed a significantly shorter time of arrival to definitive hemostasis and also demonstrated a significantly higher survival in the Kaplan-Meier survival analysis (P=0.014, Log-rank test).

CONCLUSIONS:

The arrival to access time and ISS were significantly associated with mortality in the REBOA patients in Japan. The early access group demonstrated better survival. The proactive early access in the resuscitation phase might be related to better patient outcomes.

LEVEL OF EVIDENCE:

Therapeutic/care management, level V.

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