Resuscitative endovascular balloon occlusion of the aorta (REBOA) in penetrating abdominal vascular injuries is associated with worse outcomes

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) may benefit patients with severe subdiaphragmatic traumatic hemorrhage. This study compares outcomes in patients with penetrating abdominal vascular injury treated with REBOA versus those managed without REBOA.

Methods

Using the Trauma Quality Improvement Program (TQIP) database, we identified adult patients with penetrating abdominal vascular injury from 2017 to 2022. Propensity scores matched REBOA patients 1:3 with non-REBOA patients. The primary outcome was in-hospital mortality, with secondary outcomes including 24-h mortality, transfusion needs, and complications such as acute kidney injury (AKI), deep vein thrombosis (DVT), pulmonary embolism (PE), lower extremity compartment syndrome, fasciotomy, amputation, and femoral artery repair.

Results

Two hundred ninety-three REBOA patients were matched with 879 non-REBOA patients. REBOA patients had higher in-hospital mortality (46.8 ​% vs 36.3 ​%, p ​= ​0.002), packed-red blood cell (PRBC) transfusion requirements within 4 ​h (median 15.3 vs 8.2, p ​< ​0.001), AKI (8.5 ​% vs 4.7 ​%, p ​= ​0.013), fasciotomy (6.5 ​% vs 3.6 ​%, p ​= ​0.039), amputation (3.4 ​% vs 1.4 ​%, p ​= ​0.025), and femoral artery repair (3.4 ​% vs 0.6 ​%, p ​< ​0.001). In a subgroup analysis of patients without severe extra-abdominal injuries, REBOA was associated with higher in-hospital mortality (49.7 ​% vs. 38.2 ​%, p ​= ​0.013) and increased packed red blood cell (PRBC) transfusion requirements (median 14.1 vs. 8.3 units, p ​< ​0.001).

Conclusions

In penetrating abdominal vascular injuries, REBOA was associated with worse outcomes.