Potential for Resuscitative Endovascular Balloon Occlusion of the Aorta (Reboa) at a Scandinavian Trauma Referral Center

Abstract

Introduction: Noncompressible torso hemorrhage (NCTH) is a major but potentially preventable cause of trauma-related mortality. During recent years, resuscitative endovascular balloon occlusion of the aorta (REBOA) has rapidly emerged as an adjunct for hemorrhage control in trauma. Its potential benefits and harms have been debated but not fully evaluated. Importantly, little is known about the potential proportion of trauma patients in which REBOA may be used. The aim of our study was to determine this proportion. The results are important data when planning future studies and implementing new trauma protocols or local guidelines on the use of REBOA. Methods: A retrospective cohort study of all adult (≥16 y) trauma patients received and treated at our facility, a university hospital and a trauma referral center (covering approximately 2,5 million inhabitants) between years 2013-2017 was performed. The potential candidates for REBOA were patients with an abdominal and/or pelvic injury and an Abbreviated Injury Scale (AIS) score of ≥3, who arrived in shock (defined as a systolic blood pressure (SBP) 90 mmHg or less). Patients with potential contraindication for REBOA (prehospital cardiac arrest or thoracic vascular injury) were excluded. Results: From a total of 7229 patients during the study years, 31 (0,4%) patients met the criteria for potential use of REBOA. In this cohort, the total mortality was 45% and the mortality within 30 days was 26%. The dominant mechanism of injury was penetrating in 16,1% of cases. The mean Injury Severity Score (ISS) was 46,3 and mean SBP was 72 mmHg. Conclusion: The study suggests a potential indication for REBOA (incidence) of 2,5 per one million inhabitants per year according to the used criteria. Local REBOA guidelines and protocol may vary but a significant number of trauma centers use similar inclusion criteria. Although the total mortality within this group is high, the number of patients that theoretically may benefit from the use of REBOA is low. Disclosure: Nothing to disclose