Use of Intermittent Aortic Balloon Occlusion: Report from the ABO Trauma Registry

Abstract

Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a helpful adjunct in the managementof hemorrhagic shock due to bleeding in the abdomen or pelvis. Ischemia distal to the occlusion is a concern;intermittent aortic balloon inflation (i-REBOA) is a novel way to achieve decreased ischemia time.Methods: This study was conducted using data from the multinational ABO Trauma Registry. All patients enteredbetween January 2016 and December 2019 were included.Results: The sample consisted of 157 patients. There were 57 patients in the i-REBOA group (36%) and 100 in theREBOA group (64%). The groups were similar in gender (P = 0.50), age (P = 0.17), mechanism of injury (P = 0.42), andinjury severity score (P = 0.13). The levels of international normalized ratio (INR) (P < 0.01), activated partial thromboplastintime (aPTT) (P < 0.01) and lactate (P = 0.02) were higher in the i-REBOA group. Total balloon inflation times werelonger in the i-REBOA group (P < 0.01). Major complication rates did not differ between groups. Mortality rates betweengroups were similar in the Emergency Department (ED) (3.8% for i-REBOA vs 10.1%; P = 0.17), within 24 hours (43.4% fori-REBOA vs 38.2%; P = 0.54), and at 30 days (63.6% for i-REBOA vs 48.4%; P = 0.07).Conclusions: The data from this registry show that i-REBOA is currently being used and may allow for longer totalballoon inflation times without higher morbidity or mortality rates.