Resuscitative Endovascular Balloon Occlusion of the Aorta Compared with Resuscitative Thoracotomy in the United States

Purpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive technique used to control aortic hemorrhage in patients experiencing profound shock. REBOA primarily serves as a temporary course of action to bridge patients into a surgical intervention. Traditionally, the common approach to aortic hemorrhage has involved resuscitative thoracotomy (RT) with aortic clamping. Our study compares REBOA with RT by evaluating peri- and postoperative outcomes.

Materials and Methods: The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) was used to extract procedure data from 2017. Patients who underwent REBOA (n = 83) were compared with patients who underwent RT (n = 114). Cox proportional hazard analysis was conducted comparing survival in the intensive care unit (ICU) between the two procedures. Regression results are depicted as hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). Kaplan-Meier curve was created to depict survival time; Wilcoxon rank-sum test was used to compare survival time between the two groups. Student t-test was used to compare complications between REBOA and RT. REBOA is contraindicated for patients with cardiac arrests; therefore, these patients were excluded. In addition, patients who underwent the procedures more than 1 hour after arrival at the emergency department (ED), transferred from another hospital, or died in the ED were all excluded.

Results: Those who underwent REBOA had a higher proportion of acute kidney injury complications than those who underwent RT (8 [9.64%] vs 1 [0.88%]; P = 0.004) and pulmonary embolism (5 [6.02%] vs 0 [0.00%]; P = 0.008). However, Cox proportional hazard analysis indicated that the inpatient mortality rate was less likely in REBOA cohort compared with RT (HR, 0.49; 95% CI, 0.250–0.997; P = 0.049), adjusted for patient demographics and comorbidities. Patients who underwent REBOA had a higher average survival time in the ICU compared with patients who underwent RT (41.4 days vs 14.9 days, respectively; P = 0.021).

Conclusions: Patients who underwent REBOA had a higher rate of survival in the ICU than those who underwent RT. Surgeons should consider performing REBOA in patients with aortic hemorrhage. We recommend further research on the efficacy and safety of REBOA.