Feasibility and Clinical Outcome Of REBOA in Patients With Impending Traumatic Cardiac Arrest

Abstract

Introduction: Globally, trauma with massive bleeding is the leading cause of death under the age of 40 years [1]. Those who survive the initial trauma may die within the first few hours because of hemorrhage and cardiac arrest [2]. Hypotension with a decrease in systolic blood pressure (SBP) is a late indicator of shock and occurs when vasoconstriction fails to raise the SBP [3]. Cardiopulmonary resuscitation (CPR) is initiated when the carotid pulse cannot be palpated in an unresponsive patient, in whom SBP would have decreased to 40 mm Hg or less [4]. This does not per se confirm a “true” cardiac arrest but may represent a state of inadequate perfusion with impending cardiac arrest (ICA). If no intervention is performed at this stage, a true cardiac arrest will follow [5, 6]. Resuscitative thoracotomy (RT) is indicated in trauma patients with ongoing CPR (< 15 min) and in patients with profound refractory shock [7]. The aim of the RT is to address intra-thoracic injuries, perform open CPR and compress the thoracic aorta while resuscitating the patient with blood products. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapidly evolving technique that can possibly replace the role of RT and temporarily stabilize the hemodynamics of exsanguinating patients [8, 9]. It would, therefore, be of interest to study the subgroup of patients presenting with ICA. We aimed to study the feasibility and clinical outcome of REBOA in patients with ICA using data from the ABOTrauma Registry. Methods: Retrospective and prospective data on the use of REBOA in patients with ICA (SBP ≤40 mmHg upon REBOA inflation) from 16 centers globally were collected and reported to the ABOTrauma Registry. SBP was measured both at pre- and post-REBOA inflation. Data collected included patients' demography, vascular access technique, number of attempts, catheter size, operator, zone and duration of occlusion, and clinical outcome. Results: There were 71 patients in this high-risk patient group. REBOA was performed on all patients, in a majority using a 7Fr catheter placed on the first attempt through blind insertion and inflated in Zone I for a period of 30 to 60 minutes by ER doctors, trauma surgeons or vascular surgeons. SBP significantly improved following the inflation of REBOA and 38% of the patients survived. Conclusion: Our study has shown that REBOA is feasible in patients with ICA, SBP can be elevated in these patients with a 38% survival rate. Disclosure: Author Y. Matsumura is on the clinical advisory board for TOKAII Medical Products.