Abstract 190: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) After Traumatic Brain Injury

Abstract

Aim: The effects of resuscitative endovascular balloon occlusion of the aorta (REBOA) on progression of traumatic brain injury (TBI) are unclear. Swine models have shown conflicting results, and human data is lacking. Two hypotheses largely prevail: increased mean arterial pressure caused by REBOA may improve cerebral perfusion, or conversely, cause cerebral edema due to elevated blood and intracranial pressure. This study aims to compare outcomes in patients with TBI treated with and without REBOA. Methods: A retrospective analysis compared blunt trauma patients with TBI treated with REBOA to those treated without. REBOA patients were selected from the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry, and non-REBOA patients were selected from an institutional trauma registry. Patients with SBP > 0mmHg at admission and at initiation of aortic occlusion were included. Patients requiring CPR at ED were excluded. Propensity score matching was performed using age, gender, ISS, AIS-Head, and admission SBP. Results: After matching, 106 REBOA patients and 106 non-REBOA patients remained for analysis. REBOA patients had significantly higher ISS, but there was no difference in AIS-Head, pre-hospital or ED GCS, ED SBP, or in-hospital mortality (Table). Despite longer hospital stays for REBOA patients, there was no difference in ICU length of stay or rate of discharge home between groups. Conclusion: REBOA was used in more severely injured patients, but was not associated with higher mortality rate. Despite longer hospital stays for REBOA patients, discharge GCS and rate of discharge home, both favorable patient-centered outcomes, were similar between groups. REBOA use should be considered for use in patients with non-compressible torso hemorrhage and concomitant TBI, as it here it did not increase mortality, and outcomes upon discharge are similar to patients treated without REBOA.