BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging treatment for noncompressible torso hemorrhage. It remains unclear if REBOA is superior to resuscitative thoracotomy with aortic cross-clamping (RT) in terms of improving outcomes. This study compared in-hospital outcomes between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock, using data from a national inpatient database in Japan.
METHODS: Using the Diagnosis Procedure Combination database, we identified patients who received REBOA or RT within 1 day after admission from July 1, 2010, to March 31, 2014. We excluded those with penetrating thoracic injuries. Propensity score–adjusted analyses were performed to compare in-hospital mortality and other in-hospital outcomes.
RESULTS: Eligible patients (n = 259) were classified into the REBOA group (n = 191) or the RT group (n = 68). In the propensity score–adjusted Cox regression analysis, the two groups did not differ significantly with respect to in-hospital mortality (hazard ratio, 0.94; 95% confidence interval, 0.60–1.48). There were also no significant differences between the groups in ventilator-free days, intensive care unit-free days, total amount of fluid infusion within 1 day after admission, total amount of transfusion within 1 day after admission, or total hospitalization costs.
CONCLUSION: In this retrospective nationwide study, in-hospital outcomes were not significantly different between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock.
LEVEL OF EVIDENCE: Therapeutic/care management, level III.
From the Department of Clinical Epidemiology and Health Economics (S.A., H.M., H. Y.), School of Public Health, The University of Tokyo; and Department of Health Policy and Informatics (K.F.), Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
Submitted: June 5, 2016, Revised: November 7, 2016, Accepted: November 16, 2016, Published online: January 3, 2017.
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Address for reprints: Shotaro Aso, MD, MPH, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; email: firstname.lastname@example.org.