Resuscitative endovascular balloon occlusion of the aorta or resuscitative thoracotomy with aortic clamping for noncompressible torso hemorrhage

A retrospective nationwide study

Abstract

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.