The Fog has not Lifted: No Reduction in Complications for Partial REBOA in the AAST AORTA Registry

Authors

  • Micaela Gomez Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
  • Elizabeth Wood Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
  • Juhi Saxena Wake Forest School of Medicine, Winston Salem, NC, USA
  • Lucas P Neff Department of Pediatric Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
  • Maximilian Peter Forssten Department of Orthopedic Surgery, Örebro University Hospital, Sweden
  • Austin Johnson Department of Emergency Medicine, University of Utah, Salt Lake City, UT, USA
  • Timothy K Williams Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
  • Marcelo Ribeiro Jr Department of Surgery, Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
  • Bellal Joseph Department of Surgery, University of Arizona, Tucson, AZ, USA
  • Joseph DuBose Department of Surgery and Perioperative Care at Dell Medical School, Austin, TX, USA
  • Shahin Mohseni School of Medical Sciences, Örebro University, Sweden https://orcid.org/0000-0001-7097-487X

DOI:

https://doi.org/10.26676/jevtm.25486

Keywords:

Resuscitative Endovascular Balloon Occlusion of the AORTA (REBOA), Partial REBOA (pREBOA), Complete REBOA (cREBOA), Hemorrhagic Shock, Resuscitation Adjunct

Abstract

Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a potentially lifesaving but polarizing therapy due to the associated morbidity and uncertainty of who might benefit. Techniques such as partial (p)REBOA that provide hemodynamic support while reducing distal ischemia are now captured in the Aortic Resuscitation in Trauma and Acute Care (AORTA) registry. We hypothesized that pREBOA would be associated with improved mortality and fewer adverse outcomes.
Methods: The AORTA registry was queried for adult patients who received complete (c)REBOA or pREBOA between 2020 and 2022. Patients were excluded if they had a head Abbreviated Injury Scale (AIS) ≥three or an AIS of six in any body region. Outcome measures were complications and mortality. Poisson regression analyses identified the independent effect of the type of approach on outcomes.
Results: 164 patients met the inclusion criteria, with pREBOA used in 36% of cases and no significant difference in patient demographics, injury characteristics, or injury severity between pREBOA and cREBOA. There was no difference in mortality rate (44.1% vs 45.7%). After adjusting for potential confounders, no statistically significant difference in complications was detected between the two approaches [adjusted IRR (95% CI): 1.11 (0.54–2.27), p = 0.777]. This association persisted after subgroup analysis of aortic Zone one vs Zone three deployment.
Conclusions: In this registry analysis, pREBOA did not reduce morbidity or mortality compared to cREBOA. Improving the granularity of clinical metrics in the AORTA registry is essential to understanding whether patients will benefit from pREBOA, and how to best implement this controversial resuscitation adjunct.

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Published

2024-09-23

How to Cite

Gomez, M., Wood, E., Saxena, J., Neff, L. P., Forssten, M. P., Johnson, A., … Mohseni, S. (2024). The Fog has not Lifted: No Reduction in Complications for Partial REBOA in the AAST AORTA Registry. Journal of Endovascular Resuscitation and Trauma Management, 8(2). https://doi.org/10.26676/jevtm.25486

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Original Article

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