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A feasibility study of partial REBOA data in a high-volume trauma center

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporize patients with infradiaphragmatic hemorrhage. Current guidelines advise < 30 min, to avoid ischemia/ reperfusion injury, whenever possible. The technique of partial REBOA (P-REBOA) has been developed to minimize the effects of distal ischemia. This study presents our clinical experience with P-REBOA, comparing outcomes to complete occlusion (C-REBOA).

Patients and methods

Retrospective analysis of patients’ electronic data and local REBOA registry between January 2016 and May 2019. Inclusion criteria: adult trauma patients who received Zone I C-REBOA or P-REBOA for infradiaphragmatic hemorrhage, who underwent attempted exploration in the operating room. Comparison of outcomes based on REBOA technique (P-REBOA vs C-REBOA) and occlusion time (> 30 min, vs ≤ 30 min)

Results

46 patients were included, with 14 treated with P-REBOA. There were no demographic differences between P-REBOA and C-REBOA. Prolonged (> 30 min) REBOA (regardless of type of occlusion) was associated with increased mortality (32% vs 0%, p = 0.044) and organ failure. When comparing prolonged P-REBOA with C-REBOA, there was a trend toward lower ventilator days [19 (11) vs 6 (9); p = 0.483] and dialysis (36.4% vs 16.7%; p = 0.228) with significantly less vasopressor requirement (72.7% vs 33.3%; p = 0.026).

Conclusion

P-REBOA can be delivered in a clinical setting, but is not currently associated with improved survival in prolonged occlusion. In survivors, there is a trend toward lower organ support needs, suggesting that the technique might help to mitigate ischemic organ injury. More clinical data are needed to clarify the benefit of partial occlusion REBOA.

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Funding

Funding for this study was received from Prytime Medical Inc, Boerne, TX. The funding source had no involvement in study design, collection, analysis or interpretation of data, in the writing of the report, or decision to submit the article for publication.

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Authors and Affiliations

  1. R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Marta J. Madurska, Thomas M. Scalea, Rishi Kundi, Jonathan J. Morrison & Joseph J. DuBose

  2. Philadelphia College of Osteopathic Medicine, Philadelphia, PA, 19131, USA

    Ashley McLenithan

  3. Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences and The Walter Reed National Military Medical Center, Bethesda, MD, USA

    Joseph M. White

Authors
  1. Marta J. Madurska
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  2. Ashley McLenithan
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  3. Thomas M. Scalea
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  4. Rishi Kundi
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  5. Joseph M. White
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  6. Jonathan J. Morrison
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  7. Joseph J. DuBose
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Corresponding author

Correspondence to Jonathan J. Morrison.

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Conflict of interest

Jonathan J Morrison is on the Clinical Advisory Board for Prytime Medical Inc, Boerne, TX. For the remaining authors, no conflicts were declared.

Ethics approval

This study was approved by the University of Maryland, Baltimore Institutional Review Board (IRB), # HM-HP-00055545-25. The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.

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Madurska, M.J., McLenithan, A., Scalea, T.M. et al. A feasibility study of partial REBOA data in a high-volume trauma center. Eur J Trauma Emerg Surg 48, 299–305 (2022). https://doi.org/10.1007/s00068-020-01561-4

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  • DOI: https://doi.org/10.1007/s00068-020-01561-4

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