ABSTRACT
Introduction: The introduction of low profile devices designed for Resuscitative
Endovascular Balloon Occlusion of the Aorta (REBOA) after trauma has the potential to
change practice, outcomes and complication profiles related to this procedure.
Methods: The AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care
Surgery (AORTA) registry was utilized to identify REBOA patients from 16 centers
-comparing presentation, intervention and outcome variables for those REBOA via
traditional 11-12 access platforms and trauma-specific devices requiring only 7 F access.
Results:From Nov 2013-Dec 2017, 242 patients with completed data were identified,
constituting 124 7F and 118 11-12F uses. Demographics of presentation were not
different between the two groups, except that the 7F patients had a higher mean ISS (39.2
34.1, p = 0.028). 7F device use was associated with a lower cut-down requirement for
access (22.6% vs. 37.3%, p = 0.049) and increased ultrasound guidance utilization (29.0%
23.7%, p = 0.049). 7F device afforded earlier aortic occlusion in the course of
resuscitation (median 25.0 mins vs. 30 mins, p = 0.010), and had lower median PRBC
(10.0 vs. 15.5 units, p = 0.006) and FFP requirements (7.5 vs. 14.0 units, p = 0.005). 7F
patients were more likely to survive 24 hrs (58.1% vs. 42.4%, p = 0.015) and less likely
to suffer in-hospital mortality (57.3% vs. 75.4%, p = 0.003). Finally, 7F device use was
associated with a 4X lower rate of distal extremity embolism (20.0% vs. 5.6%, p =
0.014;OR 95% CI 4.25 [1.25-14.45]) compared to 11-12F counterparts.
Conclusion: The introduction of trauma specific 7F REBOA devices appears to have
influenced REBOA practices, with earlier utilization in severely injured hypotensive
patients via less invasive means that are associated with lower transfusion requirements
fewer thrombotic complications and improved survival. Additional study is required to determine optimal REBOA
utilization.
