New data from Japan shows a significant survival advantage for resuscitative endovascular balloon occlusion of the aorta (REBOA) compared to the more familiar aortic cross clamping (ACC) for trauma patients who suffer cardiac arrest in the hospital, according to research presented Saturday during the Resuscitation Science Symposium at Scientific Sessions.
“For patients with severe abdominal or pelvic injuries, REBOA may be the only practical intervention,” said Toshikazu Abe, MD, MPH, visiting professor of health services research at the University of Tsukuba and chief of emergency and critical care medicine at Tsukuba Medical Center Hospital, Tsukuba, Japan.
Abe presented the results of the world’s largest retrospective cohort study of REBOA versus ACC. No randomized controlled trials have compared the two interventions, noted Abe, adding that it would be almost impossible to design such a trial. The study was among the “Best of the Best” oral abstract presentations at the 2016 Resuscitation Science Symposium.
Researchers used the Japan Trauma Data Bank, a nationwide trauma injury registry, to construct a cohort of all adult trauma patients who underwent either REBOA or ACC in 2004-2013. They identified 903 patients — 636 who received REBOA and 267 who received ACC — from the 159,157 trauma patients in the registry. Patients with cardiopulmonary arrest before arrival at the hospital or with an Abbreviated Injury Scale (AIS) score of six or higher were excluded.
Of the patients in the analysis, 67 percent who received REBOA died compared to 90 percent of the patients who received ACC. Patients with REBOA had a higher Revised Trauma Sore (RTS) compared to those with ACC, 5.2 versus 4.2 (p<0.001), and a higher probability of survival, 0.43 versus 0.27 (p<0.001), respectively. REBOA had an odds ratio for in-hospital mortality of 0.309 after adjusting for Trauma and Injury Severity Score. There were similar results after adjusting for RTS (OR=0.224) and Injury Severity Score (OR=0.188).
In a propensity score-matched cohort of 304 patients, REBOA was associated with lower mortality compared to ACC, OR=0.261. Patients with REBOA had less severe chest complications than those with ACC, AIS chest 3.8 versus 4.2 (p<0.001), even though the physiological severity and backgrounds were similar in both groups.
“I think what we are seeing is the result of REBOA being a less invasive, less traumatic procedure for these patients because it is an endovascular intervention,” Abe said. “If you don’t have to open the chest, it may be that patients are less likely to die.”