Abstract 20176: Partial Occlusion With REBOA Strategy for Traumatic Hemorrhagic Shock Patients Would Be Feasible and Safe, but Available for Only Lower Physiological Severity Patients Compared With Full Occlusion Treatment Cases

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Abstract

Introduction: Recently, REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) for a traumatic hemorrhagic shock patient has been drawing international attention as one of the first-line procedures. Some papers reported that REBOA was less invasive than resuscitative open aortic cross clamping and effective for critically hemorrhagic shock. On the other side, some studies pointed out that REBOA treatment was associated with a higher mortality and full occlusion (f-REBOA) over 45minutes caused ischemic deadly complications. Then, the treatment with partial occlusion (p-REBOA) has been proposing as one of the best way. But it is still unclear which treatment is better and adjust for which patients. So, we studied the possibility of partial REBOA to severe traumatic patients

Methods: Consecutive traumatic hemorrhagic shock patients who were undergone REBOA at our ER, and whose hemodynamics were temporary stabilized with REBOA and could get through a fundamental hemostasis were included. They were sorted into f-REBOA group (groupF) and p-REBOA group (groupP). The primary end point was a survival rate at 30 days after injury. Secondary end points were fluid factors as total amount of bleeding, crystalloid infusion and blood transfusion, and ischemic or reperfusion complications.

Results: 48 trauma patients were treated with REBOA and 30 patients were succeeded in REBOA resuscitation and sorted into two groups (GroupF 16 patients and GroupP 14 patients). There were no significant differences between age, rate of blunt trauma, ISS, sBP before occlusion or shock index, any laboratory data. RTS (Revised Trauma Score) was significantly lower in GroupF (GroupF vs. GroupP: 3.61 vs. 5.36, p=0.02). Total duration of REBOA and OM/TAE were not different significantly. There were no significant difference in a survival rate (6/16 (38%) vs. 9/14 (64%)), amount of fluid factors and rate of complications.

Conclusion: p-REBOA did not increase any amount of bleeding, blood transfusion, complications and mortality rate compared with f-REBOA. But RTS in p-REBOA was significantly lower. Then p-REBOA would be feasible and safe for traumatic hemorrhagic shock patients, but it might not be available in higher physiological severity patients.

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