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Resuscitative endovascular balloon occlusion of the aorta or resuscitative thoracotomy with aortic clamping for noncompressible torso hemorrhage: A retrospective nationwide study

Aso, Shotaro MD, MPH; Matsui, Hiroki MPH; Fushimi, Kiyohide MD, PhD; Yasunaga, Hideo MD, PhD

Journal of Trauma and Acute Care Surgery: May 2017 - Volume 82 - Issue 5 - p 910–914
doi: 10.1097/TA.0000000000001345
Original Articles

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

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: asou-sin@umin.ac.jp.

© 2017 Lippincott Williams & Wilkins, Inc.