An assessment of nationwide trends in emergency department (ED) resuscitative endovascular balloon occlusion of the aorta (REBOA) use - A trauma quality improvement program registry analysis

Hamza Hanif; Andrew D Fisher; Michael D April; Julie A Rizzo; Richard Miskimins; Joseph D Dubose; Michael W Cripps; Steven G Schauer

doi:10.1016/j.amjsurg.2024.115898

An assessment of nationwide trends in emergency department (ED) resuscitative endovascular balloon occlusion of the aorta (REBOA) use - A trauma quality improvement program registry analysis

Am J Surg. 2024 Dec:238:115898. doi: 10.1016/j.amjsurg.2024.115898. Epub 2024 Aug 13.

Authors

Hamza Hanif¹, Andrew D Fisher², Michael D April³, Julie A Rizzo⁴, Richard Miskimins⁵, Joseph D Dubose⁶, Michael W Cripps⁷, Steven G Schauer⁸

Affiliations

¹ University of New Mexico Hospital, Albuquerque, NM, USA. Electronic address: [email protected].
² University of New Mexico Hospital, Albuquerque, NM, USA; Texas National Guard, Austin, TX, USA.
³ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁴ Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Trauma, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, USA.
⁵ University of New Mexico Hospital, Albuquerque, NM, USA.
⁶ Department of Surgery, University of Texas Dell School of Medicine, Austin, TX, USA.
⁷ Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
⁸ Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Center for Combat and Battlefield Research (COMBAT), University of Colorado School of Medicine, Aurora, CO, USA.

PMID: 39173564
DOI: 10.1016/j.amjsurg.2024.115898

Abstract

Background: Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for temporary hemorrhage control in severe non-compressible torso trauma remains controversial, with limited data on patient selection and outcomes. This study aims to analyze the nationwide trends of its use in the emergency department (EDs).

Methods: A retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) from 2017 to 2022 was performed, focusing on REBOA placements in EDs.

Results: The analysis included 3398 REBOA procedures. Majority patients were male (76 %) with a median age of 40 years (27-58) and injury severity score of 20 (20-41). The most common mechanism was collision (64 %), with emergency surgeries most frequently performed for pelvic trauma (14 %). Level 1 trauma centers performed 82 % of these procedures, with consistent low annual utilization (<200 facilities). Survival rates were 85 % at 1-h post-placement, decreasing significantly to 42 % by discharge.

Conclusions: REBOA usage in remains limited but steady, primarily occurring at level 1 trauma center EDs. While short-term survival rates are favorable, they drop significantly by the time of discharge.

Keywords: Aortic occlusion; Endovascular; Hemorrhage; REBOA; Trauma.

MeSH terms

Adult
Aorta / surgery
Balloon Occlusion* / methods
Emergency Service, Hospital* / statistics & numerical data
Endovascular Procedures* / methods
Endovascular Procedures* / trends
Female
Hemorrhage / epidemiology
Hemorrhage / therapy
Humans
Injury Severity Score
Male
Middle Aged
Quality Improvement*
Registries*
Resuscitation* / methods
Retrospective Studies
Trauma Centers
United States