Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2020 Mar 30;15(1):23.
doi: 10.1186/s13017-020-00301-8.

Pre-hospital CPR and early REBOA in trauma patients - results from the ABOTrauma Registry

Peter Hilbert-Carius  1 , David T McGreevy  2 , Fikri M Abu-Zidan  3 , Tal M Hörer  2 ; the ABOTrauma Registry research group
Collaborators, Affiliations
Multicenter Study

Pre-hospital CPR and early REBOA in trauma patients - results from the ABOTrauma Registry

Peter Hilbert-Carius et al. World J Emerg Surg. .

Abstract

Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR.

Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate.

Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to the hospital with ongoing CPR. Nine patients (35%) died within the first 24 h, while seventeen patients (65%) survived post 24 h. The survival rate to hospital discharge was 27% (n = 7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p = 0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. The survival rate in the 16 patients responding to REBOA was 37.5% (n = 6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from the median (range) 56.5 (0-147) to 90 (0-200) mmHg.

Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated.

Keywords: CPR; Cardiac arrest; Endovascular resuscitation; REBOA; Trauma.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart visualizing who received REBOA post-ROSC vs. pre-ROSC. TCA traumatic cardiac arrest, ROSC return of spontaneous circulation
Fig. 2
Fig. 2
Boxplot of systolic blood pressure (mmHg) immediately before and after REBOA inflation for 26 patients who had pre-hospital CPR and early REBOA after hospital admission The interquartile range (IQR) is resembled by the box where it begins with the 25th percentile and ends with the 75th percentile. The median is represented as a line within the box. ***p = 0.001
See this image and copyright information in PMC

References

    1. Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. Emerg Med J. 2015;32(12):911–915. - PMC - PubMed
    1. Harris T, Masud S, Lamond A, Abu-Habsa M. Traumatic cardiac arrest: a unique approach. Eur J Emerg Med. 2015;22(2):72–78. - PubMed
    1. McGreevy DT, Abu-Zidan FM, Sadeghi M, Pirouzram A, Toivola A, Skoog P, et al. Feasibility and clinical outcome of REBOA in patients with impending traumatic cardiac arrest. Shock. 2019. - PubMed
    1. Truhlar A, Deakin CD, Soar J, Khalifa GE, Alfonzo A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015;95:148–201. - PubMed
    1. Burlew CC, Moore EE, Moore FA, Coimbra R, McIntyre RC, Jr, Davis JW, et al. Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012;73(6):1359–1363. - PubMed

Publication types

LinkOut - more resources