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Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma

A propensity score analysis

Inoue, Junichi MD; Shiraishi, Atsushi MD, PhD; Yoshiyuki, Ayako MD; Haruta, Koichi MD; Matsui, Hiroki MPH; Otomo, Yasuhiro MD, PhD

Journal of Trauma and Acute Care Surgery: April 2016 - Volume 80 - Issue 4 - p 559–567
doi: 10.1097/TA.0000000000000968
AAST 2015 Plenary Papers
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BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a key procedure in early trauma care that provides hemorrhage control in hemodynamically unstable torso trauma patients. However, the clinical efficacy of REBOA remains uncertain. The objective of this study was to estimate the efficacy of REBOA in surgically treated severe torso trauma patients.

METHODS We obtained data from the nationwide trauma registry in Japan (the Japan Trauma Data Bank) for trauma subjects who had undergone emergency surgery or transcatheter embolization against torso trauma. A logistic regression analysis estimated a propensity score to predict REBOA use from available predictors of in-hospital mortality. We then used a propensity score matching analysis to compare in-hospital mortality and door–to–primary surgery time in subjects who underwent REBOA and those who did not. In addition, we used an instrumental variable method to adjust for unmeasured confounding variables as a sensitivity analysis.

RESULTS Overall, 12,053 of the 183,457 trauma patients registered in the Japan Trauma Data Bank were eligible based on selection criteria. Propensity score matching selected 625 patients each for the with-REBOA and without-REBOA groups. The in-hospital mortality was significantly higher in subjects who underwent REBOA (61.8% vs. 45.3%; absolute difference, +16.5%; 95% confident interval, +10.9% to +22.0%). Door–to–primary surgery time was shorter in subjects who underwent REBOA than in those who did not (97 minutes vs. 110 minutes; absolute difference, −14 minutes; 95% confidence interval, −25 minutes to −3 minutes). The sensitivity analysis with the instrumental variable method did not alter the results and estimated nonsignificantly higher in-hospital mortality in REBOA subjects (+16.4%; 95% confidence interval, −0.6% to 33.3%).

CONCLUSION This study showed an association between the use of REBOA and excess mortality in patients with hemodynamically unstable torso trauma that had a median door–to–primary surgery time of 97 minutes. Further observational studies with detailed REBOA data are necessary to assess whether selected trauma subgroups could benefit from REBOA.

LEVEL OF EVIDENCE Therapeutic study, level III.

From the Tokyo Medical Dental University, Tokyo, Japan.

Submitted: August 17, 2015, Revised: December 28, 2015, Accepted: December 30, 2015, Published online: January 21, 2016.

This study was presented at the 74th annual meeting of the American Association for the Surgery of Trauma, September 9–12, 2015, in Las Vegas, Nevada.

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 website (www.jtrauma.com).

Address for reprints: Atushi Shiraishi, MD, PhD, Tokyo Medical Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan 113–8510; email: siris.accm@tmd.ac.jp.

© 2016 Lippincott Williams & Wilkins, Inc.