Isolated Severe Pelvic Fractures Treated With or Without Resuscitative Endovascular Balloon Occlusion of the Aorta: A Matched Cohort Study

Abstract

INTRODUCTION: Previous studies have revealed resuscitative endovascular balloon occlusion of the aorta (REBOA) may be correlated with higher mortality and acute kidney injury rates in severely injured patients. This study investigated outcomes in severe pelvic fracture patients with or without REBOA. METHODS: This was a retrospective study of patients with severe pelvic fracture (pelvis AIS 3 or greater) in the TQIP database (2013 to 2018). Patients were excluded if transferred from another hospital, without sign of life in the emergency department, died in the emergency department, there was a penetrating mechanism, or other than lower extremity region AIS greater than 3. Propensity score matching was performed with age, vital signs, Injury Severity Score, comorbidities, each AIS region scores, and hollow viscus injuries. Outcomes were mortality and complications, including acute kidney injury, ARDS, venous thromboembolism, deep venous thrombosis, severe sepsis, and ventilator-associated pneumonia or pneumonia. RESULTS: A total of 376 patients were matched: 94 patients with REBOA and 282 patients without. REBOA patients were more likely to undergo laparotomy (62.8% vs 42.9%, p < 0.001) and had higher transfusion rates (12 vs 5 units PRBC, p < 0.001). The REBOA group had worse 24-hour mortality (23.1% vs 13.2%; p = 0.024), worse in-hospital mortality (31.9% vs 21.3%, p = 0.036), higher venous thromboembolism rate (13.8% vs 6.7%, p = 0.033) and higher deep venous thrombosis rate (11.7% vs 6.3%, p = 0.009; Table). Table. - Postmatched Outcome Variable Total, N = 376 No REBOA, n = 282 (75%) REBOA, n = 94 (25%) p Value HLOS, days * 15.0 (6.0–28.0) 15.0 (7.0–27.0) 18.0 (2.0–28.0) 0.947 ICU LOS, days* 7.0 (3.0–15.0) 7.0 (3.0–15.0) 7.5 (3.0–14.0) 0.676 AKI 30 (8%) 19 (6.7%) 11 (11.7%) 0.124 ARDS 12 (3.2%) 10 (3.5%) 2 (2.2%) 0.738 VTE 32 (8.5%) 19 (6.7%) 13 (13.8%) 0.033 DVT 23 (6.1%) 12 (4.3%) 11 (11.7%) 0.009 VAP or pneumonia 19 (5.1%) 15 (5.3%) 4 (4.3%) 0.792 24-h mortality* 58 (15.6%) 37 (13.2%) 21 (23.1%) 0.024 In-hospital mortality 90 (23.9%) 60 (21.3%) 30 (31.9%) 0.036 AKI, acute kidney injury; DVT, deep venous thrombosis; HLOS, hospital length of stay; LOS, length of stay; REBOA, resuscitative endovascular balloon occlusion of the aorta; VAP, ventilator-associated pneumonia; VTE, venous thromboembolism. CONCLUSION: REBOA use in severe pelvic trauma patients is correlated with higher rates of mortality, venous thromboembolism, and deep venous thrombosis compared with no REBOA. Further randomized controlled studies should be designed to verify the benefits of REBOA use in severe trauma patients.