Partial occlusion, conversion from thoracotomy, undelayed but shorter occlusion: resuscitative endovascular balloon occlusion of the aorta strategy in Japan

Eur J Emerg Med. 2018 Oct;25(5):348-354. doi: 10.1097/MEJ.0000000000000466.


Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable alternative to resuscitative thoracotomy (RT) in refractory hemorrhagic patients. We evaluated REBOA strategies using Japanese multi-institutional data.

Patients and methods: The DIRECT-IABO investigators registered trauma patients requiring REBOA from 18 hospitals. Patients' characteristics, outcomes, and time in initial treatment were collected and analyzed.

Results: From August 2011 to December 2015, 106 trauma patients were analyzed. The majority of patients were men (67%) (median BMI of 22 kg/m, 96% blunt injured). REBOA occurred in the field (1.9%, all survived >30 days), emergency department (75%), angiography suite (17%), and operating room (1.9%). Initial deployment was at zone I in 93% and partial occlusion in 70% of cases. RT and REBOA were combined in 30 patients (RT+REBOA group) who showed significantly higher injury severity score (44 vs. 36, P=0.001) and chest abbreviated injury scale (4 vs. 3; P<0.001) than the REBOA-alone group (n=76). Frequent cardiopulmonary resuscitation (73%), longer prothrombin time-international normalised ratio, lower pH, and higher lactate were observed in the RT+REBOA. Among 24 h nonsurvivors (n=30) of the REBOA alone, preocclusion systolic blood pressure was lower (43 vs. 72 mmHg; P=0.002), indicating impending cardiac arrest, and duration of occlusion was longer (60 vs. 31 min; P=0.010). In the RT+REBOA (n=30), six survived beyond 24 h, three beyond 30 days, and achieved survival discharge.

Conclusion: Partial occlusion was performed in 70% of patients. Undelayed deployment of REBOA without presenting impending cardiac arrest with shorter balloon occlusion (<30 min at zone I with partial occlusion) might be related to successful hemodynamic stabilization and improved survival. Further evaluation should be performed prospectively.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aortic Rupture / diagnosis
  • Aortic Rupture / mortality
  • Aortic Rupture / therapy
  • Balloon Occlusion / methods*
  • Balloon Occlusion / mortality
  • Cardiopulmonary Resuscitation / methods*
  • Cardiopulmonary Resuscitation / mortality
  • Cause of Death*
  • Cohort Studies
  • Conversion to Open Surgery / methods*
  • Conversion to Open Surgery / mortality
  • Death, Sudden, Cardiac / prevention & control
  • Female
  • Hemodynamics / physiology
  • Humans
  • Injury Severity Score
  • Japan
  • Male
  • Middle Aged
  • Registries*
  • Retrospective Studies
  • Shock, Hemorrhagic / diagnosis
  • Shock, Hemorrhagic / mortality
  • Shock, Hemorrhagic / therapy*
  • Statistics, Nonparametric
  • Survival Analysis
  • Thoracic Injuries / diagnosis
  • Thoracic Injuries / mortality
  • Thoracic Injuries / therapy
  • Thoracotomy / methods
  • Time Factors