Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

Ramiro Manzano-Nunez, David McGreevy, Claudia P. Orlas, Alberto F. Garciá, Tal M. Hörer, Joseph Dubose, Carlos A. Ordoñez, Jonny Morrison, Thomas M. Scalea, Laura J. Moore, Jeanette M. Podbielski, John B. Holcomb, Kenji Inaba, Alice Piccinini, David S. Kauvar, Valorie L. Baggenstoss, Catherine Rauschendorfer, Jeremey Cannon, Mark Seamon, Ryan DumasMike Vella, Jessica Guzman, Chance Spalding, Timothy W. Wolff, Chuck Fox, Ernest Moore, David Turay, Cassra N. Arbabi, Xian Luo-Owen, David Skarupa, Jennifer A. Mull, Joannis Baez Gonzalez, Joseph Ibrahim, Karen Safcsak, Stephanie Gordy, Michael Long, Andrew W. Kirkpatrick, Chad G. Ball, Zhengwen Xiao, Elizabeth Dauer, Jennifer Knight, Nicole Cornell, Forrest Dell Moore, Matthew Bloom, Nam T. Tran, Eileen Bulger, Jeannette G. Ward, John K. Bini, John Matsuura, Joshua Pringle

Resultado de la investigación: Contribución a una revistaArtículorevisión exhaustiva

1 Cita (Scopus)

Resumen

Background
Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries’ income based on the World Bank Country and Lending Groups.

Methods
We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality.

Results
A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36‑1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63‑3,33; p = 0.3).

Conclusion
There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.
Idioma originalInglés estadounidense
Número de artículo57
Número de páginas8
PublicaciónWorld Journal of Emergency Surgery
Volumen15
N.º1
DOI
EstadoPublicada - oct 12 2020
Publicado de forma externa

All Science Journal Classification (ASJC) codes

  • Cirugía
  • Medicina de urgencias

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