Identifying potential utility of REBOA: An autopsy study

Bellal A Joseph, Kareem Ibraheem, Ansab A. Haider, Narong Kulvatunyou, Andrew - Tang, Terence S Okeeffe, Zachary M. Bauman, Donald J J Green, Rifat - Latifi, Peter M Rhee

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However; with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention like RT is being discussed. The aim of this study was to identify patients that most likely would have potentially benefitted from REBOA use based on autopsy findings. METHODS: We performed a four-year retrospective review of all RT performed at our Level I trauma center. Patients with in-hospital mortality and who underwent subsequent autopsies were included. Patients were divided into blunt and penetrating trauma with and without thoracic injuries. Autopsy reports were reviewed to identify vascular and solid organ injuries. Outcome measure was potential benefit with REBOA. Potential benefit with REBOA was defined based on the ability to safely deploy REBOA. In patients without cardiac, aortic and major pulmonary vasculature injuries, REBOA was considered Potentially Beneficial. In all other patients it was considered as Non-Beneficial. RESULTS: A total of 98 patients underwent a RT of which 87 had subsequent autopsies and were reviewed. The mean age was 35.25±17.85 years, mean admission systolic blood pressure was 51.38±70.11 mm of Hg, median Injury Severity Score 30 [25-43], and 44 had penetrating injury. REBOA would have been potentially beneficial in 51.2% (22/43) of patients with blunt mechanism of trauma while 38.6% of (17/44) patients with penetrating mechanism of trauma. A subgroup analysis showed that REBOA use would have been potentially beneficial in 50.0% blunt thoracic and 33.3% penetrating thoracic trauma patients. CONCLUSION: There is a great enthusiasm and premature efforts to introduce REBOA as an alternative to RT. While there exists a great potential for benefit with REBOA use in the management of NCTH, the current indications for REBOA need to be defined better. Penetrating chest trauma patients in extremis should be considered an absolute contraindication for REBOA use. Majority of patients with blunt trauma in extremis may potentially benefit from REBOA. However, better criteria will help increase these patients who may potentially benefit from REBOA placement. LEVEL OF EVIDENCE: Prognostic study, level III.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - May 18 2016

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Balloon Occlusion
Aorta
Autopsy
Thoracotomy
Wounds and Injuries
Thorax
Blood Pressure
Thoracic Injuries
Injury Severity Score
Hemorrhagic Shock
Trauma Centers
Lung Injury
Hospital Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Identifying potential utility of REBOA : An autopsy study. / Joseph, Bellal A; Ibraheem, Kareem; Haider, Ansab A.; Kulvatunyou, Narong; Tang, Andrew -; Okeeffe, Terence S; Bauman, Zachary M.; Green, Donald J J; Latifi, Rifat -; Rhee, Peter M.

In: Journal of Trauma and Acute Care Surgery, 18.05.2016.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However; with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention like RT is being discussed. The aim of this study was to identify patients that most likely would have potentially benefitted from REBOA use based on autopsy findings. METHODS: We performed a four-year retrospective review of all RT performed at our Level I trauma center. Patients with in-hospital mortality and who underwent subsequent autopsies were included. Patients were divided into blunt and penetrating trauma with and without thoracic injuries. Autopsy reports were reviewed to identify vascular and solid organ injuries. Outcome measure was potential benefit with REBOA. Potential benefit with REBOA was defined based on the ability to safely deploy REBOA. In patients without cardiac, aortic and major pulmonary vasculature injuries, REBOA was considered Potentially Beneficial. In all other patients it was considered as Non-Beneficial. RESULTS: A total of 98 patients underwent a RT of which 87 had subsequent autopsies and were reviewed. The mean age was 35.25±17.85 years, mean admission systolic blood pressure was 51.38±70.11 mm of Hg, median Injury Severity Score 30 [25-43], and 44 had penetrating injury. REBOA would have been potentially beneficial in 51.2{\%} (22/43) of patients with blunt mechanism of trauma while 38.6{\%} of (17/44) patients with penetrating mechanism of trauma. A subgroup analysis showed that REBOA use would have been potentially beneficial in 50.0{\%} blunt thoracic and 33.3{\%} penetrating thoracic trauma patients. CONCLUSION: There is a great enthusiasm and premature efforts to introduce REBOA as an alternative to RT. While there exists a great potential for benefit with REBOA use in the management of NCTH, the current indications for REBOA need to be defined better. Penetrating chest trauma patients in extremis should be considered an absolute contraindication for REBOA use. Majority of patients with blunt trauma in extremis may potentially benefit from REBOA. However, better criteria will help increase these patients who may potentially benefit from REBOA placement. LEVEL OF EVIDENCE: Prognostic study, level III.",
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AU - Joseph, Bellal A

AU - Ibraheem, Kareem

AU - Haider, Ansab A.

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AU - Tang, Andrew -

AU - Okeeffe, Terence S

AU - Bauman, Zachary M.

AU - Green, Donald J J

AU - Latifi, Rifat -

AU - Rhee, Peter M

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N2 - BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However; with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention like RT is being discussed. The aim of this study was to identify patients that most likely would have potentially benefitted from REBOA use based on autopsy findings. METHODS: We performed a four-year retrospective review of all RT performed at our Level I trauma center. Patients with in-hospital mortality and who underwent subsequent autopsies were included. Patients were divided into blunt and penetrating trauma with and without thoracic injuries. Autopsy reports were reviewed to identify vascular and solid organ injuries. Outcome measure was potential benefit with REBOA. Potential benefit with REBOA was defined based on the ability to safely deploy REBOA. In patients without cardiac, aortic and major pulmonary vasculature injuries, REBOA was considered Potentially Beneficial. In all other patients it was considered as Non-Beneficial. RESULTS: A total of 98 patients underwent a RT of which 87 had subsequent autopsies and were reviewed. The mean age was 35.25±17.85 years, mean admission systolic blood pressure was 51.38±70.11 mm of Hg, median Injury Severity Score 30 [25-43], and 44 had penetrating injury. REBOA would have been potentially beneficial in 51.2% (22/43) of patients with blunt mechanism of trauma while 38.6% of (17/44) patients with penetrating mechanism of trauma. A subgroup analysis showed that REBOA use would have been potentially beneficial in 50.0% blunt thoracic and 33.3% penetrating thoracic trauma patients. CONCLUSION: There is a great enthusiasm and premature efforts to introduce REBOA as an alternative to RT. While there exists a great potential for benefit with REBOA use in the management of NCTH, the current indications for REBOA need to be defined better. Penetrating chest trauma patients in extremis should be considered an absolute contraindication for REBOA use. Majority of patients with blunt trauma in extremis may potentially benefit from REBOA. However, better criteria will help increase these patients who may potentially benefit from REBOA placement. LEVEL OF EVIDENCE: Prognostic study, level III.

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