Highlights from #AAST2014 - Is REBOA better than ED Thoracotomy?

Former County resident Dr. Laura Moore presented a controversial paper about REBOA.  Controversial, but already hailed as a possible landmark article.

RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA (REBOA) IS A FEASIBLE ALTERNATIVE TO RESUSCITATIVE THORACOTOMY IN TRAUMA PATIENTS WITH NON-COMPRESSIBLE

TRUNCAL HEMORRHAGE AND PROFOUND HEMORRHAGIC SHOCK

Laura J. Moore* MD, Megan Brenner MD, Rosemary A. Kozar* MD,Ph.D., Jason Pasley DO, Charles Wade* Ph.D., Thomas Scalea* MD, John B. Holcomb* MD, University of Texas Health Science Center-Houston

Invited Discussant: Timothy Fabian, MD

Introduction: Hemorrhageremainstheleadingcauseofdeathintraumapatients. Proximal aortic occlusion, usually performed by direct aortic cross-clamping via thoracotomy, can provide temporary hemodynamic stability, permitting definitive injury repair. Resuscitative endovascular balloon occlusion of the aorta (REBOA), utilizes a minimally-invasive, trans-femoral balloon catheter which is rapidly inserted retrograde and inflated for aortic occlusion, may control inflow and allow time for hemostasis. We compared resuscitative thoracotomy with aortic cross-clamping (RT) to REBOA in trauma patients in profound hemorrhagic shock.

Methods: Trauma registry data was utilized to compare all patients undergoing RT or REBOA over an 18 month period from two Level one trauma centers. Groups were compared using a t-test, p value <0.05 considered significant.

Results: There was no difference between RT (n=72) and REBOA groups (n=24) in terms of demographics, mechanism of injury, injury severity score (40.6 vs. 31.4, p=0.17), admission base deficit (12.9 vs. 11, p=0.31), or initial blood pressure (70.9 vs. 55.8, p=0.15). REBOA had fewer early deaths (see table) and improved overall survival as compared to RT (37.5% vs. 9.7%, p=0.003).

	Resuscitative Thoracotomy (RT) Deaths (n=65)	REBOA Deaths (n=15)	p value
Died in ED (%)	69.2%	26.7%	0.002
Died in OR (%)	9.3%	20%	0.234
Died in ICU (%)	21.5%	53.3%	0.013

Conclusions: REBOA is a feasible and controls non-compressible truncal hemorrhage in trauma patients in profound shock. Patients undergoing REBOA have improved overall survival and fewer early deaths as compared to patients undergoing RT.