Endovascular balloon occlusion of the aorta in the complex of damage control resuscitation in patients with acute massive blood loss: a retrospective propensity score matched analysis

Abstract

INTRODUCTION. An increase of quality improvement program for severe polytrauma hypotensive patients is associated with new techniques of “endovascular resuscitation” of which resuscitative endovascular balloon occlusion of the aorta (REBOA) to be the most widespread and effective. OBJECTIVE. Treatment outcomes after damage control resuscitation and endovascular resuscitation strategies were evaluated in comparison between Russian and “foreign” cohorts. MATERIALS AND METHODS. A retrospective and propensity score matched analysis was performed to compare Russian (n = 24) and foreign (n = 241) cohorts of extremely severely injured trauma patients (in extremis) admitted to trauma centers during the period of 2013–2020. All hemodynamically unstable trauma patients admitted in shock, with signs of systemic hypoperfusion and non-compressible torso hemorrhage, were enrolled into the study. RESULTS. In average, REBOA was performed 22 minutes after admission in both groups. In most cases (65–75 %), occlusion of the thoracic aorta was performed, what resulted in a significant increase of blood pressure by 40–50 mm Hg from baseline and allowed temporary hemodynamic stabilization to initiate surgery and blood replacement therapy. Early fluid and blood replacement therapy was significantly different between groups. Total volume of fluid and blood replacement therapy was significantly higher in the foreign group (p = 0.001), mostly due to blood components: red packed blood cells and platelets (p < 0.05 before and after REBOA). No colloids were infused in the foreign group at all (p < 0.001). Early blood transfusion was found to improve survival until 50 % (95% CI, 43–56 %) (р = 0.002). CONCLUSIONS. REBOA seems to be an effective adjunct for temporary hemodynamic stabilization of extremely severe injured patients, but its effectiveness is likely to be defined by quality and quantity of infusion and transfusion strategy as well as by intensive care in whole.