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The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA)

DuBose, Joseph J. MD; Scalea, Thomas M. MD; Brenner, Megan MD; Skiada, Dimitra MD; Inaba, Kenji MD; Cannon, Jeremy MD; Moore, Laura MD; Holcomb, John MD; Turay, David MD; Arbabi, Cassra N. MD; Kirkpatrick, Andrew MD; Xiao, James MD; Skarupa, David MD; Poulin, Nathaniel MDthe AAST AORTA Study Group

Journal of Trauma and Acute Care Surgery: September 2016 - Volume 81 - Issue 3 - p 409–419
doi: 10.1097/TA.0000000000001079
AAST 2015 Plenary Papers
Editor's Choice

INTRODUCTION Aortic occlusion (AO) for resuscitation in traumatic shock remains controversial. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers an emerging alternative.

METHODS The American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry prospectively identified trauma patients requiring AO from eight ACS Level 1 centers. Presentation, intervention, and outcome variables were collected and analyzed to compare REBOA and open AO.

RESULTS From November 2013 to February 2015, 114 AO patients were captured (REBOA, 46; open AO, 68); 80.7% were male, and 62.3% were blunt injured. Aortic occlusion occurred in the emergency department (73.7%) or the operating room (26.3%). Hemodynamic improvement after AO was observed in 62.3% [REBOA, 67.4%; open OA, 61.8%); 36.0% achieving stability (systolic blood pressure consistently >90 mm Hg, >5 minutes); REBOA, 22 of 46 (47.8%); open OA, 19 of 68 (27.9%); p =0.014]. Resuscitative endovascular balloon occlusion of the aorta (REBOA) access was femoral cut-down (50%); US guided (10.9%) and percutaneous without imaging (28.3%). Deployment was achieved in Zones I (78.6%), II (2.4%), and III (19.0%). A second AO attempt was required in 9.6% [REBOA, 2 of 46 (4.3%); open OA, 9 of 68 (13.2%)]. Complications of REBOA were uncommon (pseudoaneurysm, 2.1%; embolism, 4.3%; limb ischemia, 0%). There was no difference in time to successful AO between REBOA and open procedures (REBOA, 6.6 ± 5.6 minutes; open OA, 7.2 ± 15.1; p = 0.842). Overall survival was 21.1% (24 of 114), with no significant difference between REBOA and open AO with regard to mortality [REBOA, 28.2% (13 of 46); open OA, 16.1% (11 of 68); p = 0.120].

CONCLUSION Resuscitative endovascular balloon occlusion of the aorta has emerged as a viable alternative to open AO in centers that have developed this capability. Further maturation of the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database is required to better elucidate optimal indications and outcomes.

LEVEL OF EVIDENCE Therapeutic/care management study, level IV.

From the David Grant Medical Center (J.J.D.), University of California–Davis, Davis, California; Department of Surgery (T.M.S., M.B.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland; Los Angeles County + University of Southern California Hospital (D.S., K.I.), Los Angeles, California; San Antonio Military Medical Center (J.C.), United States Army Institute of Surgical Research, San Antonio, Texas; University of Texas Health Sciences Center–Houston (L.M., J.H.), Houston, Texas; Loma Linda University Medical Center (D.T., C.N.A.), Loma Linda, California; University of Calgary (A.K., J.X.), Calgary, Alberta, Canada; University of Florida–Jacksonville (D.S.), Jacksonville, Florida; and East Carolina Medical Center (N.P.), New Bern, North Carolina.

Submitted: August 26, 2015, Revised: January 4, 2016, Accepted: January 5, 2016, Published online: April 5, 2016.

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

The AAST AORTA Study Group is composed of the following: Joe DuBose, MD, David Grant Medical Center/University of California–Davis; Megan Brenner, MD, Melanie Hoehn, MD, Todd Rasmussen, MD, and Tom Scalea, MD, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, MD; Dimitra Skiada, MD, and Kenji Inaba, MD, Los Angeles County + University of Southern California Hospital, Los Angeles, CA; Jeremy Cannon, MD, J. Devin Watson, MD, Kevin Chung, MD, and Michael Dubick, PhD, San Antonio Military Medical Center/United States Army Institute of Surgical Research, San Antonio, TX; Laura Moore, MD, Jeanette M Podbielski, RN, CCRP, and John B. Holcomb, MD, University of Texas Health Sciences Center–Houston, Houston, TX; David Turay, MD, Cassra N. Arbabi, MD, Thomas A. O'Callaghan, MD, and Xian Luo-Owen, MD, PhD, Loma Linda University Medical Center, Loma Linda, CA; Andrew Kirkpatrick, MD, James Xiao, MD, and Chad Ball, MD, University of Calgary; David Skarupa, MD, University of Florida–Jacksonville; and Nathaniel Poulin, MD, East Carolina Medical Center.

Address for reprints: Joseph DuBose, MD, FACS, FCCM, 101 Boden Circle, Travis Air Force Base, CA 94535, Lt Col, USAF MC; email: jjd3c@yahoo.com.

© 2016 Lippincott Williams & Wilkins, Inc.