TY - JOUR
T1 - Resuscitative endovascular balloon occlusion of the aorta and traumatic out-of-hospital cardiac arrest
T2 - A nationwide study
AU - Yamamoto, Ryo
AU - Suzuki, Masaru
AU - Funabiki, Tomohiro
AU - Nishida, Yusho
AU - Maeshima, Katsuya
AU - Sasaki, Junichi
N1 - Publisher Copyright:
© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.
PY - 2020/8
Y1 - 2020/8
N2 - Objective: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive method for temporary hemostasis compared with cross-clamping the aorta through resuscitative thoracotomy (RT). Although the survival benefits of REBOA remained unclear, pathophysiological benefits were identified in patients with traumatic out-of-hospital cardiac arrest (t-OHCA). We examined the clinical outcomes of t-OHCA with the hypothesis that REBOA would be associated with higher survival to discharge compared with RT. Methods: A retrospective cohort study was conducted using the Japan Trauma Data Bank (2004–2019). Adult patients with t-OHCA who had arrived without a palpable pulse and undergone aortic occlusion were included. Patients were divided into REBOA or RT groups, and propensity scores were developed using age, mechanism of injury, presence of signs of life, presence of severe head and/or chest injury, Injury Severity Score, and transportation time. Inverse probability weighting by propensity scores was performed to compare survival to discharge between the 2 groups. Results: Among 13,247 patients with t-OHCA, 1483 were included in this study. A total of 144 (9.7%) patients were treated with REBOA, and 5 of 144 (3.5%) in the REBOA group and 10 of 1339 (0.7%) in the RT group survived to discharge. The use of REBOA was significantly associated with increased survival to discharge (odds ratio, 4.78; 95% confidence interval, 1.61–14.19), which was confirmed by inverse probability weighting (adjusted odds ratio, 3.73; 95% confidence interval, 1.90–7.32). Conclusions: REBOA for t-OHCA was associated with higher survival to discharge. These results should be validated by further research.
AB - Objective: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive method for temporary hemostasis compared with cross-clamping the aorta through resuscitative thoracotomy (RT). Although the survival benefits of REBOA remained unclear, pathophysiological benefits were identified in patients with traumatic out-of-hospital cardiac arrest (t-OHCA). We examined the clinical outcomes of t-OHCA with the hypothesis that REBOA would be associated with higher survival to discharge compared with RT. Methods: A retrospective cohort study was conducted using the Japan Trauma Data Bank (2004–2019). Adult patients with t-OHCA who had arrived without a palpable pulse and undergone aortic occlusion were included. Patients were divided into REBOA or RT groups, and propensity scores were developed using age, mechanism of injury, presence of signs of life, presence of severe head and/or chest injury, Injury Severity Score, and transportation time. Inverse probability weighting by propensity scores was performed to compare survival to discharge between the 2 groups. Results: Among 13,247 patients with t-OHCA, 1483 were included in this study. A total of 144 (9.7%) patients were treated with REBOA, and 5 of 144 (3.5%) in the REBOA group and 10 of 1339 (0.7%) in the RT group survived to discharge. The use of REBOA was significantly associated with increased survival to discharge (odds ratio, 4.78; 95% confidence interval, 1.61–14.19), which was confirmed by inverse probability weighting (adjusted odds ratio, 3.73; 95% confidence interval, 1.90–7.32). Conclusions: REBOA for t-OHCA was associated with higher survival to discharge. These results should be validated by further research.
KW - OHCA
KW - REBOA
KW - aortic occlusion
KW - balloon occlusion
KW - cardiac arrest
KW - mortality
KW - resuscitative thoracotomy
KW - traumatic cardiac arrest
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U2 - 10.1002/emp2.12177
DO - 10.1002/emp2.12177
M3 - Article
AN - SCOPUS:85107696653
SN - 2688-1152
VL - 1
SP - 624
EP - 632
JO - JACEP Open
JF - JACEP Open
IS - 4
ER -