Survival benefit for pelvic trauma patients undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta: Results of the AAST Aortic Occlusion for Resuscitation in Trauma Acute Care Surgery (AORTA) Registry

• Published in: Injury 2022-06, Vol.53 (6), p.2126-2132
• Main Authors: Bini, John K., Hardman, Claire, Morrison, Jonathon, Scalea, Thomas M., Moore, Laura J., Podbielski, Jeanette M, Inaba, Kenji, Piccinini, Alice, Kauvar, David S., Cannon, Jeremey, Spalding, Chance, Fox, Charles, Moore, Ernest, DuBose, Joseph J.
• Format: Article
• Language: English
• Subjects: aortic occlusion; non-compressible; pelvic hemorrhage; REBOA
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.03.005

•Survival advantage in patients bleeding below the aortic bifurcation and who underwent Zone 3 REBOA as a means of AO as compared to open AO.•This is the first study to look specifically at this patient population and compare open AO to REBOA.•The survival advantage seen with REBOA was accomplished without increasing systemic complications and blood component utilization. Aortic occlusion (AO) to facilitate the acute resuscitation of trauma and acute care surgery patients in shock remains a controversial topic. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an increasingly deployed method of AO. We hypothesized that in patients with non-compressible hemorrhage below the aortic bifurcation, the use of REBOA instead of open AO may be associated with a survival benefit. From the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry, we identified 1494 patients requiring AO from 45 Level I and 4 Level II trauma centers. Presentation, intervention, and outcome variables were analyzed to compare REBOA vs open AO in patients with non-compressible hemorrhage below the aortic bifurcation. From December 2014 to January 2019, 217 patients with Zone 3 REBOA or Open AO who required pelvic packing, pelvic fixation or pelvic angio-embolization were identified. Of these, 109 AO patients had injuries isolated to below the aortic bifurcation (REBOA, 84; open AO, 25). Patients with intra-abdominal or thoracic sources of bleeding, above deployment Zone 3 were excluded. Overall mortality was lower in the REBOA group (35.% vs 80%, p