Usefulness of resuscitative endovascular balloon occlusion of the aorta compared to aortic cross‐clamping in severely injured trauma patients: Analysis from the Japan Trauma Data Bank

Abstract

Aim To compare in‐hospital mortality of severely injured trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) or aortic cross‐clamping (ACC). Methods In this multicenter, retrospective cohort study using data from a nationwide trauma registry of tertiary emergency medical centers in Japan (n = 280), trauma patients who underwent aortic occlusion at the emergency department from 2004 to 2019 were divided into two groups according to the treatment they received: patients treated with ACC and patients who underwent placement of a REBOA catheter. Multiple imputations were used to handle the missing data. In‐hospital mortality of the patients who underwent REBOA or ACC was compared using a mixed‐effect logistic regression analysis and a propensity score‐matching analysis, in which the confounders, including baseline patient demographics and severity, were adjusted. Results Of 1,670 patients (1,137 with REBOA and 533 with ACC), 66% were male. The median age was 56 years, and the mortality rate was 55.2% in the REBOA group and 81.6% in the ACC group. The mixed‐effect model regression analysis showed a significantly lower odds ratio for in‐hospital mortality rate in the REBOA group (odds ratio 0.17; 95% confidence interval, 0.12–0.26). A similar odds ratio was observed in the propensity score matching analysis (odds ratio 0.27; 95% confidence interval, 0.18–0.40). Conclusion Compared with ACC, REBOA use was associated with decreased mortality in severely injured trauma patients.

Keywords

• Aortic occlusion
• clinical assessment
• resuscitation
• trauma
• trauma registry