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. 2021 Apr 1;90(4):659-665.
doi: 10.1097/TA.0000000000003053.

Patterns and outcomes of zone 3 REBOA use in the management of severe pelvic fractures: Results from the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database

Melike Harfouche  1 , Kenji Inaba, Jeremy Cannon, Mark Seamon, Ernest Moore, Thomas Scalea, Joseph DuBose
Affiliations

Patterns and outcomes of zone 3 REBOA use in the management of severe pelvic fractures: Results from the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database

Melike Harfouche et al. J Trauma Acute Care Surg. .

Abstract

Background: Knowledge on practice patterns for aortic occlusion (AO) in the setting of severe pelvic fractures is limited. This study aimed to describe clinical outcomes based on number and types of interventions after zone 3 resuscitative endovascular balloon occlusion of the aorta (REBOA) deployment.

Methods: A retrospective review of the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery multicenter registry was performed for patients who underwent zone 3 AO from 2013 to 2020. Patients with a blunt mechanism who survived beyond the emergency department were included. Interventions evaluated were preperitoneal pelvic packing (PP), angioembolization (AE), and external fixation (EF) of the pelvis. Management approaches were compared against the primary outcome of mortality. Secondary outcomes included transfusion requirements, overall complications and acute kidney injury (AKI).

Results: Of 207 patients who underwent zone 3 AO, 160 (77.3%) fit the inclusion criteria. Sixty (37.5%) underwent AO alone, 50 (31.3%) underwent a second hemostatic intervention, and 49 (30.6%) underwent a third hemostatic intervention. Overall mortality was 37.7% (n = 60). There were no differences in mortality based on any number or combination of interventions. On multivariable regression, only EF was associated with a mortality reduction (odds ratio, 0.22; p = 0.011). Increasing number of interventions were associated with higher transfusion and complication rates. Pelvic packing + AE was associated with increased AKI than PP or AE alone (73.3% vs. 29.5% and 28.6%, p = 0.005), and AE was associated with increased AKI resulting in dialysis than PP alone (17.9% vs. 6.8%, p = 0.036).

Conclusion: Zone 3 REBOA can be used as a standalone hemorrhage control technique and as an adjunct in the management of severe pelvic fractures. The only additional intervention associated with a mortality reduction was EF. The benefit of increasing number of interventions must be weighed against more harm. Heterogeneity in practice patterns for REBOA use in pelvic fracture management underscores the need for an evidence base to standardize care.

Level of evidence: Therapeutic, Level IV.

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References

    1. Rieger J, Linsenmaier U, Euler E, Rock C, Pfeifer KJ. Temporary balloon occlusion as therapy of uncontrollable arterial hemorrhage in multiple trauma patients. RöFo . 1999;170(1):80–83.
    1. Martinelli T, Thony F, Decléty P, Sengel C, Broux C, Tonetti J, Payen JF, Ferretti G. Intra-aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures. J Trauma . 2010;68(4):942–948.
    1. Morrison JJ, Percival TJ, Markov NP, Villamaria C, Scott DJ, Saches KA, Spencer JR, Rasmussen TE. Aortic balloon occlusion is effective in controlling pelvic hemorrhage. J Surg Res . 2012;177(2):341–347.
    1. Magee GA, Fox CJ, Moore EE. Resuscitative endovascular balloon occlusion of the aorta in pelvic ring fractures: the Denver health protocol. Injury . 2020;S0020138320300723.
    1. Burlew CC, Moore EE, Stahel PF, Geddes AE, Wagenaar AE, Pieracci FM, Fox CJ, Campion EM, Johnson JL, Mauffrey C. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma Acute Care Surg . 2017;82(2):233–242.