Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock

Abstract

Introduction: Intra-aortic balloon occlusion (IABO) is useful for proximal vascular control, by clamping the descending aorta, in traumatic haemorrhagic shock. However, there are limited clinical studies regarding its effectiveness. This study aimed at investigating the effectiveness of IABO for traumatic haemorrhagic shock.

Methods: This retrospective, observational study included trauma patients who underwent IABO at the Emergency and Critical Care Center of Nippon Medical School Tama-Nagayama Hospital between January 2009 and March 2013. 14 patients were included to this study who were in shock on arrival (systolic blood pressure [SBP] <90 mmHg or shock index ≥1), underwent IABO for resuscitation and temporary haemostasis, and subsequently underwent haemostatic intervention (operation or transcatheter arterial embolization). Patient characteristics, physiological status, SBP, heart rate (HR), initial fluid and blood transfusion, time course, and total occlusion time were compared before and after IABO as well as between the survived (n = 5) and non-survived (n = 9) groups.

Results: The majority of patients experienced blunt injuries, with an average injury severity score of 29.5. The liver, pelvis, spleen, and mesenterium represented the majority of injured organs. SBP, but not HR, was significantly higher after IABO than before IABO (123.1 vs. 65.5 mmHg, P = 0.0001). The revised trauma score and probability of survival were significantly different between the survived and non-survived groups (both, P = 0.04). The survived group required significantly less blood transfusion volume than the non-survived group (20 vs. 33.7 red blood cell units, P = 0.04). In addition, the survived group required a significantly shorter total occlusion time than the non-survived group (46.2 vs. 224.1 min, P = 0.002).

Conclusions: IABO was used for relatively severe trauma patients. SBP was significantly higher after IABO, but was not related to survival. However, blood transfusion volume and total occlusion time were related to survival; therefore, it is important to reduce or shorten these parameters, i.e., immediate definitive haemostasis. IABO is effective for traumatic haemorrhagic shock; however, it is also important to consider these points and potential complications.

Keywords: Haemorrhagic shock; Intra-aortic balloon occlusion (IABO); Proximal vascular control; Trauma.

Figure 1

Comparison of systolic blood pressure (SBP) of trauma patients who underwent intra-aortic balloon occlusion (IABO). A: Comparison of SBP before and after IABO in all cases (n = 14). B: Comparison of the change in SBP (∆SBP) between the survived group (n = 5) and non-survived group (n = 9). Values are reported as mean ± SE, analysed using a Wilcoxon signed rank test (A) or Mann-Whitney U test (B). *P < 0.05, **P < 0.01, ***P < 0.001.

Figure 2

Comparison of heart rate (HR) of trauma patients who underwent intra-aortic balloon occlusion (IABO). A: Comparison of HR before and after IABO in all cases (n = 14). B: Comparison of the change in HR (∆HR) between the survived group (n = 5) and non-survived group (n = 9). Values are reported as mean ± SE, analysed using a Wilcoxon signed rank test (A) or Mann-Whitney U test (B).

Figure 3

Comparison of initial fluid and blood transfusion in trauma patients who underwent intra-aortic balloon occlusion (IABO). A: Comparison of initial fluid (crystalloid volume within 24 hours of arrival) between the survived group (n = 5) and non-survived group (n = 9). B: Comparison of blood transfusion (red blood cell [RBC] units within 24 hours of arrival) requirements between the survived group (n = 5) and non-survived group (n = 9). Values are reported as mean ± SE, analysed using a Mann-Whitney U test. *P < 0.05.

Figure 4

Comparison of the time course in trauma patients who underwent intra-aortic balloon occlusion (IABO). A: Comparison of time from injury to IABO insertion between the survived group (n = 5) and non-survived group (n = 9); B: Comparison of time from arrival to IABO insertion between the survived group (n = 5) and non-survived group (n = 9); C: Comparison of time from IABO insertion to intervention start between the survived group (n = 5) and non-survived group (n = 9). Values are reported as mean ± SE, analysed using a Mann-Whitney U test.

Figure 5

Comparison of total occlusion time in trauma patients who underwent intra-aortic balloon occlusion (IABO), between the survived group (n = 5) and non-survived group (n = 9). Values are reported as mean ± SE, analysed using a Mann-Whitney U test. *P < 0.05, **P < 0.01, ***P < 0.001.