Background: The clinical efficacy of the resuscitative endovascular balloon of the Aorta (REBOA) for trauma has been controversial, and the complications related REBOA couldn’t be ignored. We hypothesis the appropriate way to perform REBOA for the appropriate trauma patient at the appropriate timing improves the outcome. The aim of this study is the exploration for the appropriate patient and the appropriate timing of REBOA.
Method: This is a single-center retrospective study. The trauma patients performed REBOA from Apr. 2009 to Mar. 2016 were included. First, the medical records were reviewed, and a clinical feature of the need for REBOA was surveyed. Second, a comparative study between the survivors (at 24 hours from their injuries) group and the non-survivors group was conducted, and the timing of REBOA to avoid hemorrhagic death was analyzed. Finally, a multivariate logistic regression analysis was performed to identify the independent prognostic factors. The patients with cardiac arrest on arrival were excluded.
Results: 56 patients were enrolled. The median age of this population was 66 year-old, and ISS was 50, RTS was 5.88, and Ps (TRISS) was 20.2%, and the survival rate was 55.4%. All patients needed the Massive Transfusion (MT), 96.4% had AIS 3 or more of abdominal or pelvic or both injuries, and the median blood pressure before REBOA was 70mmHg. In the comparison, the survivor group included 33 patients and the non-survivor group included 23 patients. In the non-survivors, ISS, the time length from the arrival to REBOA, the total infused volume (both crystalloid and transfusion) from the arrival to REBOA, and the presence of the cardiac arrest before REBOA was significantly greater than that of the survivors, and RTS, GCS, the blood pressure before REBOA was lower than that of the survivors. The multi-variable analysis showed a significant relation between the time length from the arrival to REBOA and the mortality, and between the blood pressure before REBOA and the mortality.
Conclusion: The indication for REBOA in trauma may be the subdiaphragmatic severely injured non-responsive patient to the MT. The early determination of REBOA among trauma resuscitation based on the response to the MT may improve their outcome, and warrants further investigation.