Resuscitative endovascular balloon occlusion of the aorta provides better survival outcomes for noncompressible blunt torso bleeding below the diaphragm compared to resuscitative thoracotomy

Chien-An Liao; Shu-Yi Huang; Chih-Po Hsu; Ya-Chiao Lin; Chi-Tung Cheng; Jen-Fu Huang; Hsi-Hsin Li; Wen-Ya Tung; Yi-Jung Chen; Ken-Hsiung Chen; Shih-Tien Wang

doi:10.1016/j.injury.2024.111916

Resuscitative endovascular balloon occlusion of the aorta provides better survival outcomes for noncompressible blunt torso bleeding below the diaphragm compared to resuscitative thoracotomy

Injury. 2024 Sep 23:111916. doi: 10.1016/j.injury.2024.111916. Online ahead of print.

Authors

Chien-An Liao¹, Shu-Yi Huang², Chih-Po Hsu³, Ya-Chiao Lin⁴, Chi-Tung Cheng³, Jen-Fu Huang⁵, Hsi-Hsin Li⁴, Wen-Ya Tung⁴, Yi-Jung Chen⁴, Ken-Hsiung Chen⁴, Shih-Tien Wang⁴

Affiliations

¹ Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
² Department of General Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
³ Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan.
⁴ Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan; National Quemoy University, Kinmen, Taiwan.
⁵ Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan. Electronic address: m7626@cgmh.org.tw.

PMID: 39384500
DOI: 10.1016/j.injury.2024.111916

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) serves as a bridging intervention for subsequent definitive haemorrhagic control. This study compared the clinical outcomes of REBOA and resuscitative thoracotomy (RT) in patients with bleeding below the diaphragm.

Materials and methods: This retrospective cohort study included adult trauma patients who presented to the Trauma Quality Improvement Program between 2020 and 2021 and who underwent either REBOA or RT in the emergency department (ED). Patients with severe head and chest injuries, characterised by an Abbreviated Injury Scale (AIS) score greater than 3, were excluded. The clinical data of patients treated with REBOA and those treated with RT were compared, and multivariable logistic regression (MLR) was employed to identify prognostic factors associated with mortality.

Results: A total of 346 patients were enrolled: 138 (39.9 %) received REBOA, and 208 (60.1 %) received RT at the ED. Patients in the RT group underwent ED cardiopulmonary resuscitation (CPR) more frequently (58.2 % vs. 23.2 %; p < 0.001) and had a higher mortality rate (87.0 % vs. 45.7 %; p < 0.001). Patients who died had lower Glasgow Coma Scale scores (6 [4.5] vs. 11 [4.9]; p < 0.001), underwent more ED CPR (58.6 % vs. 9.8 %; p < 0.001), and received RT more frequently (74.2 % vs. 26.5 %, p < 0.001). The MLR revealed that the major prognostic factors for mortality were systolic blood pressure (odds ratio [OR] 0.988, 95 % confidence interval [CI] 0.978-0.998; p = 0.014), ED CPR (OR 11.111, 95 % CI 4.667-26.452; p < 0.001), abdominal injuries with an AIS score ≥ 4 (OR 4.694, 95 % CI 1.921-11.467; p = 0.001) and RT (OR 5.693, 95 % CI 2.690-12.050; p < 0.001).

Conclusions: In cases of blunt trauma, prompt identification of the bleeding source is crucial. For patients with bleeding below the diaphragm, REBOA led to higher survival rates than did RT. However, it is important to consider the limitations of the database and the necessary exclusions from our analysis.

Keywords: Blunt torso trauma below the diaphragm; REBOA; RT.