RESUMO
Aim: To compare in-hospital mortality of severely injured trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) or aortic cross-clamping (ACC). Methods: In this multicenter, retrospective cohort study using data from a nationwide trauma registry of tertiary emergency medical centers in Japan (n = 280), trauma patients who underwent aortic occlusion at the emergency department from 2004 to 2019 were divided into two groups according to the treatment they received: patients treated with ACC and patients who underwent placement of a REBOA catheter. Multiple imputations were used to handle the missing data. In-hospital mortality of the patients who underwent REBOA or ACC was compared using a mixed-effect logistic regression analysis and a propensity score-matching analysis, in which the confounders, including baseline patient demographics and severity, were adjusted. Results: Of 1,670 patients (1,137 with REBOA and 533 with ACC), 66% were male. The median age was 56 years, and the mortality rate was 55.2% in the REBOA group and 81.6% in the ACC group. The mixed-effect model regression analysis showed a significantly lower odds ratio for in-hospital mortality rate in the REBOA group (odds ratio 0.17; 95% confidence interval, 0.12-0.26). A similar odds ratio was observed in the propensity score matching analysis (odds ratio 0.27; 95% confidence interval, 0.18-0.40). Conclusion: Compared with ACC, REBOA use was associated with decreased mortality in severely injured trauma patients.
RESUMO
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a key procedure in early trauma care that provides hemorrhage control in hemodynamically unstable torso trauma patients. However, the clinical efficacy of REBOA remains uncertain. The objective of this study was to estimate the efficacy of REBOA in surgically treated severe torso trauma patients. METHODS: We obtained data from the nationwide trauma registry in Japan (the Japan Trauma Data Bank) for trauma subjects who had undergone emergency surgery or transcatheter embolization against torso trauma. A logistic regression analysis estimated a propensity score to predict REBOA use from available predictors of in-hospital mortality. We then used a propensity score matching analysis to compare in-hospital mortality and door-to-primary surgery time in subjects who underwent REBOA and those who did not. In addition, we used an instrumental variable method to adjust for unmeasured confounding variables as a sensitivity analysis. RESULTS: Overall, 12,053 of the 183,457 trauma patients registered in the Japan Trauma Data Bank were eligible based on selection criteria. Propensity score matching selected 625 patients each for the with-REBOA and without-REBOA groups. The in-hospital mortality was significantly higher in subjects who underwent REBOA (61.8% vs. 45.3%; absolute difference, +16.5%; 95% confident interval, +10.9% to +22.0%). Door-to-primary surgery time was shorter in subjects who underwent REBOA than in those who did not (97 minutes vs. 110 minutes; absolute difference, -14 minutes; 95% confidence interval, -25 minutes to -3 minutes). The sensitivity analysis with the instrumental variable method did not alter the results and estimated nonsignificantly higher in-hospital mortality in REBOA subjects (+16.4%; 95% confidence interval, -0.6% to 33.3%). CONCLUSION: This study showed an association between the use of REBOA and excess mortality in patients with hemodynamically unstable torso trauma that had a median door-to-primary surgery time of 97 minutes. Further observational studies with detailed REBOA data are necessary to assess whether selected trauma subgroups could benefit from REBOA. LEVEL OF EVIDENCE: Therapeutic study, level III.