Pre-hospital CPR and early REBOA in trauma patients - Results from the ABOTrauma Registry.

10.21203/rs.2.19571/v2 ◽

2020 ◽

Author(s):

Peter Hilbert-Carius ◽

David T McGreevy ◽

Fikri M. Abu-Zidan ◽

Tal M. Hörer

Keyword(s):

Survival Rate ◽

Hospital Admission ◽

Injury Severity ◽

Balloon Occlusion ◽

Trauma Patients ◽

Probability Of Survival ◽

Traumatic Cardiac Arrest ◽

Predicted Probability ◽

Using Data

Abstract Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to hospital with ongoing CPR. Nine patients (35%) died within the first 24 hours, while seventeen patients (65%) survived post 24 hours. The survival rate to hospital discharge was 27% (n=7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p=0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. Survival rate in the 16 patients responding to REBOA was 37.5% (n=6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from median (range) 56.5 (0-147) to 90 (0-200) mmHg. Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated.

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The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2017.01.010 ◽

2017 ◽

Vol 35 (5) ◽

pp. 731-736 ◽

Cited By ~ 31

Author(s):

James Daley ◽

Jonathan James Morrison ◽

John Sather ◽

Lisa Hile

Keyword(s):

Cardiac Arrest ◽

Balloon Occlusion ◽

Traumatic Cardiac Arrest ◽

Endovascular Balloon Occlusion

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Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study

BMC Emergency Medicine ◽

10.1186/s12873-021-00499-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hiromichi Naito ◽

Tetsuya Yumoto ◽

Takashi Yorifuji ◽

Tsuyoshi Nojima ◽

Hirotsugu Yamamoto ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Risk Ratio ◽

Injury Severity ◽

Burn Injury ◽

Survival Curve ◽

Clinical Signs ◽

Transport Time ◽

Traumatic Cardiac Arrest ◽

Emergency Medical

Abstract Background Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA. Methods A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival. Results Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36–70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22–41), and median transport time was 11 min (IQR 6–17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%. Conclusion The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.

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Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00827-5 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Francois-Xavier Ageron ◽

Timothy J. Coats ◽

Vincent Darioli ◽

Ian Roberts

Keyword(s):

Tranexamic Acid ◽

Acid Treatment ◽

Injury Severity ◽

External Validation ◽

Research Network ◽

Brier Score ◽

Trauma Patients ◽

Using Data ◽

The Uk ◽

The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

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Assessing the need for resuscitative endovascular balloon occlusion of the aorta (REBOA) for management of non-compressible hemorrhage at a Canadian urban trauma centre

10.21203/rs.3.rs-198760/v1 ◽

2021 ◽

Author(s):

Elizabeth Purssell ◽

Sean Patrick ◽

Joseph Haegert ◽

Vesna Ivkov ◽

John Taylor

Keyword(s):

Injury Severity ◽

Retrospective Chart Review ◽

Balloon Occlusion ◽

Trauma Centre ◽

Trauma Patients ◽

Potential Candidate ◽

Study Objective ◽

Resuscitative Thoracotomy ◽

Less Invasive ◽

Endovascular Balloon Occlusion

Abstract Introduction Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive alternative to resuscitative thoracotomy (RT) for life threatening, infra-diaphragmatic, non-compressible hemorrhage from trauma. Existing evidence surrounding the efficacy of REBOA is conflicting; nevertheless, expert consensus suggests that REBOA should be considered in select trauma patients. There has been a paucity of studies that evaluate the potential utility of REBOA in the Canadian setting. The study objective was to evaluate the percentage of trauma patients presenting to a Level 1 Canadian trauma centre that would have met criteria for REBOA. Methods We conducted a retrospective chart review of patients recorded in the British Columbia Trauma Registry who warranted a trauma team activation (TTA) at our institution. We identified REBOA candidates using pre-defined criteria based on published guidelines. Each TTA case was screened by a reviewer, and then each Potential Candidate was reviewed by a panel of trauma physicians for determination of final candidacy. Results Fourteen patients were classified as Likely REBOA Candidates (2.2% of TTAs, median age 46.1 years, 64.3% female). These patients had a median Injury Severity Score of 31.5 (IQR 26.8). The main sources of hemorrhage in these patients were from abdominal injuries (71.4%) and pelvic fractures (42.9%). Conclusion The percentage of patients who met criteria for REBOA is similar to that of RTs performed at our Canadian institution. While REBOA would be performed infrequently, it is a less-invasive alternative to RT, which could be a potentially life-saving procedure in a small group of the most severely injured trauma patients.

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Traumatic cardiac arrest is associated with lower survival rate vs. medical cardiac arrest – Results from the French national registry

Resuscitation ◽

10.1016/j.resuscitation.2018.07.032 ◽

2018 ◽

Vol 131 ◽

pp. 48-54 ◽

Cited By ~ 8

Author(s):

Joséphine Escutnaire ◽

Michael Genin ◽

Evgéniya Babykina ◽

Cyrielle Dumont ◽

François Javaudin ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

National Registry ◽

Lower Survival Rate ◽

Lower Survival ◽

Traumatic Cardiac Arrest

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Traumatic cardiac arrest and resuscitative endovascular balloon occlusion of the aorta (REBOA): a preliminary analysis utilizing high fidelity invasive blood pressure recording and videography

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-018-0989-5 ◽

2018 ◽

Vol 45 (6) ◽

pp. 1097-1105 ◽

Cited By ~ 5

Author(s):

Philip J. Wasicek ◽

Shiming Yang ◽

William A. Teeter ◽

Peter Hu ◽

Deborah M. Stein ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Preliminary Analysis ◽

Balloon Occlusion ◽

High Fidelity ◽

Invasive Blood Pressure ◽

Pressure Recording ◽

Traumatic Cardiac Arrest ◽

Endovascular Balloon Occlusion ◽

Blood Pressure Recording

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Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

World Journal of Emergency Surgery ◽

10.1186/s13017-020-00342-z ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Peter Hilbert-Carius ◽

◽

David McGreevy ◽

Fikri M. Abu-Zidan ◽

Tal M. Hörer

Keyword(s):

Injury Severity ◽

Invasive Procedure ◽

Balloon Occlusion ◽

High Rate ◽

Future Research ◽

Trauma Patients ◽

Anatomic Landmarks ◽

Access Methods ◽

Angiography Suite ◽

Aortic Balloon Occlusion

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about “Who is and who should be performing it?” Methods Data from the international ABO (aortic balloon occlusion) Trauma Registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how, and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients. Results During the study period, 259 patients had been recorded in the registry, 72.5% (n = 188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5%, and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common femoral artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cutdown in 57 patients (24%), using ultrasound in 49 patients (21%), and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient’s age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room, and mortality. Conclusion A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cutdown is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing “Who should be performing REBOA?” future research should focus on “Which patient benefits most from REBOA?”

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