Daniela Burbano (Manizales / CO), Fernando Rodriguez-Holguin (Cali / CO), Ramiro Manzano (Cali / CO), Claudia Orlas (Cali / CO), Carlos Ordoñez (Cali / CO), Alberto Federico Garcia (Cali / CO)
Abstract text (incl. references and figure legends)
Introduction
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is matched to aortic cross-clamping (ACC) and described as a superior strategy. This study compares the severity of trauma between REBOA or ACC patients, as we believe previous studies might fall into survival and indication bias
Methods
We included patients between 2015-2017 in a Level I trauma hospital who had aortic occlusion (AO) with ACC or REBOA.
Demographics, trauma characteristics, interventions, and outcomes were analyzed. Continuous variables were compared by Wilcoxon-Mann-Whitney test; categoric variables with Chi2 or Fisher"s test
Results
We included 94 cases, 50 of ACC and 44 of REBOA. Age, sex, and ISS were similar between them. Penetrating trauma (PT) was most common in ACC than in REBOA (98% vs. 65%). REBOA had ≥1 lesioned system in 52.3% vs. 44% in ACC. Pulseless electric activity occurred in 38% of ACC and 4% of REBOA. All patients with pelvic fractures were treated with REBOA. ACC had lower heart rate (median [IQR]) (62.5 [0-115] vs 110 [95.5-132]), systolic blood pressure (median [IQR]) (40 [0-80] vs 67 [56-85]) and Glasgow coma scale (median [IQR]) (8 [3-12] vs 14 [8-15]) than REBOA. REBOA group received more hemoderivates in 24 hours (median [IQR]) (32.5 [15-50] vs 12.5 [6-27]).
Thoracic surgical approach and resuscitative thoracotomy (RT) were more common in ACC than REBOA (82% vs. 38.6% and 72% vs. 2.3%, respectively).
Blood pressure recovered after AO less often and later in ACC because of higher intraoperative death. The observed hospital survival was 70% in REBOA vs. 30% in ACC, similar to TRISS probability of survival (median [IQR]) (0.81 [0.29 - 0.95] vs. 0.31 (0.05-0.83)]
Conclusions
Both groups have divergent characteristics. ACC patients suffered more frequently PT and required RT, arrived in more deranged hemodynamic conditions, and had lower and observed probability of survival. Therefore, we believe these differences impede crude comparisons with REBOA patients
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