Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage: A 20-year experience in a Level I trauma center

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used as a noninvasive clamp of the aorta after diverse posttraumatic injuries. Balloon inflation in zone 3 (from the lower renal artery to the aortic bifurcation) can be performed to stop ongoing bleeding after severe pelvic trauma with life-threatening hemorrhage. The aim of our study was to describe our 20-year experience with REBOA in terms of efficacy and safety in patients with a suspicion of severe pelvic trauma and extreme hemorrhagic shock.

Methods: We performed a retrospective study from 1996 to 2017 in a French Level I trauma center. All consecutive patients who underwent a REBOA procedure were included. REBOA indication relied on (1) extreme hemodynamic instability (systolic arterial blood pressure [SBP] < 60 mm Hg on admission, SBP < 90 mm Hg despite initial resuscitation in the trauma bay or posttraumatic cardiac arrest) and (2) positive pelvic X-ray. Efficacy endpoints were vital signs and coagulation parameters before and after balloon inflation. Safety endpoints were REBOA-related complications: vascular events, acute renal failure, and rhabdomyolysis.

Results: Within the study period, 32 patients underwent a REBOA procedure. Only two patients had technical failure and balloon was not inflated in one patient. Nineteen patients did not survive at day 28. The REBOA significantly improved SBP from 60 (35-73) mm Hg to 115 (91-128) mm Hg (p < 0.001). We also reported a high rate of vascular complications (19%, n = 5 patients) but no amputation. Renal replacement therapy was initiated in 11 patients, and 15 patients had severe rhabdomyolysis.

Conclusion: The REBOA is safe and effective in improving hemodynamics after severe pelvic trauma and life-threatening hemorrhage. Our study supports the use of REBOA as a bridge to definitive hemostatic treatment after severe pelvic trauma.

Level of evidence: Therapeutic, level IV.