Abstract
BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is not widely adopted for pelvic fracture management. Western Trauma Association recommends REBOA for hemodynamically unstable pelvic fractures, whereas Eastern Association for the Surgery of Trauma and Advanced Trauma Life Support do not.MethodUtilizing a prospective cross-sectional survey, all 158 trauma medical directors at American College of Surgeons-verified Level I trauma centers were emailed survey invitations. The study aimed to determine the rate of REBOA use, REBOA indicators, and the treatment sequence of REBOA for hemodynamically unstable pelvic fractures.ResultsOf those invited, 25% (40/158) participated and 90% (36/40) completed the survey. Nearly half of trauma centers [42% (15/36)] use REBOA for pelvic fracture management. All participants included hemodynamic instability as an indicator for REBOA placement in pelvic fractures. In addition to hemodynamic instability, 29% (4/14) stated REBOA is used for patients who are ineligible for angioembolization, 14% (2/14) use REBOA when interventional radiology is unavailable, 7% (1/14) use REBOA for patients with a negative FAST. Fifty percent (7/14) responded that hemodynamically unstable pelvic fractures exclusively indicates REBOA placement. Hemodynamic instability for pelvic fractures was most commonly defined as systolic blood pressure of < 90 [56% (20/36)]. At centers using REBOA, REBOA was the first line of treatment for hemodynamically unstable pelvic fractures 40% (6/15) of the time.ConclusionsThere is little consensus on REBOA use for pelvic fractures at US Level I Trauma Centers, except that hemodynamically unstable pelvic fractures consistently indicated REBOA use.
Highlights
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is not widely adopted for pelvic fracture management
In addition to hemodynamic instability, 29% (4/14) stated REBOA is used for patients who are ineligible for angioembolization, 14% (2/14) use REBOA when interventional radiology is unavailable, 7% (1/14) use REBOA for patients with a negative focused assessment with sonography in trauma (FAST)
REBOA use was not significantly associated with the year that the hospital implemented the guideline for pelvic fracture management, p = 0.55; it appeared that hospitals using REBOA were following more recently published guidelines
Summary
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is not widely adopted for pelvic fracture management. Resuscitative endovascular balloon occlusion of the aorta (REBOA) for temporary hemorrhage control is an alternative to aortic cross-clamping that has been used for patients with hemodynamically unstable pelvic fractures; its use is not widely adopted [1,2,3]. The Eastern Association for the Surgery of Trauma (EAST) and Advanced Trauma Life Support (ATLS) guidelines do not include the utilization of REBOA for pelvic fracture management [8, 9]. The World Society of Emergency Surgeons (WSES) provides a more definitive guideline, stating that REBOA may provide an alternative method to aortic crossclamping for severe, hemodynamically unstable pelvic fractures [4]. Intermittent balloon inflation and deflation or partial deflation of REBOA can help restore hemodynamic stability but has not been well practiced [1, 7]
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