REBOA Does Not Help Mortality in Patients With Exsanguinating Hemorrhage

Adding resuscitative endovascular balloon occlusion of the aorta (REBOA) to standard care in the emergency department did not improve, and may even have hurt, survival in trauma patients with exsanguinating hemorrhage, according to a UK-based study published in JAMA.

“Death due to hemorrhage was more common in the REBOA and standard care group, and all of these deaths occurred within 24 hours (and most of them within 3 hours) of randomization,” wrote corresponding author Jan O. Jansen, PhD, of the Center for Injury Science at the University of Alabama at Birmingham, Birmingham, Alabama, and study coauthors.

The bayesian randomized clinical trial included 89 patients from 16 major trauma centers in the United Kingdom. Between October 2017 and March 2022, researchers randomized 46 patients to a strategy of REBOA and standard care and 44 patients to standard care alone. One patient from the standard care alone group declined consent for continued participation several days after enrollment and was not included in the analysis.

At 90 days, rates of all-cause mortality were 54% in the REBOA, and standard care group compared with 42% in the standard care alone group. Researchers reported an odds ratio of 1.58 for all-cause mortality and a posterior probability of increased odds of death of 86.9% with REBOA.

In secondary outcomes, the odds ratios for mortality and the posterior probabilities of an odds ratio greater than 1 were all increased with REBOA for 6-month, in-hospital, and 24-, 6-, and 3-hour mortality, the study found. Odds ratios were increased for earlier mortality end points. Deaths due to bleeding were 32% in the REBOA and standard care group and 17% in the standard care alone, according to the study.

“In trauma patients with exsanguinating hemorrhage, a strategy of REBOA and standard care in the emergency department does not reduce, and may increase, mortality compared with standard care alone,” researchers concluded.

Reference

Jansen JO, Hudson J, Cochran C, et al. Emergency department resuscitative endovascular balloon occlusion of the aorta in trauma patients with exsanguinating hemorrhage: the UK-REBOA randomized clinical trial. JAMA. 2023;330(19):1862-1871. doi:10.1001/jama.2023.20850