Delays in Surgical Intervention and Temporary Hemostasis Using Resuscitative Endovascular Balloon Occlusion of the aorta (REBOA): Influence of Time to Operating Room on Mortality

• Published in: The American journal of surgery Vol. 220; no. 6; pp. 1485 - 1491
• Main Authors: Yamamoto, Ryo, Cestero, Ramon F., Muir, Mark T., Jenkins, Donald H., Eastridge, Brian J., Funabiki, Tomohiro, Sasaki, Junichi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020; Elsevier Limited
• Subjects: Algorithms; Aorta; Aorta, Thoracic - injuries; Balloon Occlusion - methods; Cardiovascular system; Catheters; Coronary vessels; Data collection; Endovascular Procedures - methods; Female; Glasgow Coma Scale; Hemorrhage; Hemostasis; Hemostatic Techniques; Hemostatics; Hospital Mortality; Hospitals; Humans; Injury Severity Score; Intervention; Japan; Male; Medical imaging; Middle Aged; Mortality; Occlusion; Operating Rooms; Ostomy; Patients; Physicians; Population; Registries; Resuscitation; Resuscitation - methods; Resuscitative endovascular balloon occlusion of the aorta; Retrospective Studies; Subgroups; Surgery; Survival; Survival Rate; Time-to-Treatment; Trauma; Veins & arteries; Vital signs; Wounds and Injuries - mortality; Wounds and Injuries - surgery; Wounds and Injuries - therapy; Japan; Trauma; Resuscitation; Resuscitative endovascular balloon occlusion of the aorta
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.07.017

The optimal candidates for resuscitative endovascular balloon occlusion of the aorta (REBOA) remain unclear. We hypothesized that patients who experience delays in surgical intervention would benefit from REBOA. Using the Japan Trauma Databank (2014–2019), patients transferred to the operating room (OR) within 3 h were identified. Patients treated with REBOA were matched with those without REBOA using propensity scores, and further divided based on the transfer time to OR: ≤ 1 h (early), 1–2 h (delayed), and >2 h (significantly-delayed). Survival to discharge was compared. Among 5258 patients, 310 underwent REBOA. In 223 matched pairs, patients treated with REBOA had improved survival (56.5% vs. 31.8%; p < 0.01), although in-hospital mortality was reduced by REBOA only in the delayed and significantly-delayed subgroups (HR = 0.43 [0.28–0.65] and 0.42 [0.25–0.71]). REBOA-treated trauma patients who experience delays in surgical intervention (>1 h) have improved survival. •In trauma patients, REBOA use was associated with improved survival to discharge.•Patients who experienced delays in surgical intervention benefited from REBOA.•Survival benefit with REBOA was not found in patients transferred to OR within 1 h.