Worse outcomes with resuscitative endovascular balloon occlusion of the aorta in severe pelvic fracture: A matched cohort study

Chih-Ying Chien; Meghan R Lewis; Joshua Dilday; Subarna Biswas; Yong Luo; Demetrios Demetriades

doi:10.1016/j.amjsurg.2022.09.057

Worse outcomes with resuscitative endovascular balloon occlusion of the aorta in severe pelvic fracture: A matched cohort study

Am J Surg. 2023 Feb;225(2):414-419. doi: 10.1016/j.amjsurg.2022.09.057. Epub 2022 Oct 10.

Authors

Chih-Ying Chien¹, Meghan R Lewis², Joshua Dilday², Subarna Biswas², Yong Luo³, Demetrios Demetriades⁴

Affiliations

¹ Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States; Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
² Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States.
³ Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States; Trauma Center & Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
⁴ Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States. Electronic address: demetrios.demetriades@med.usc.edu.

PMID: 36253317
DOI: 10.1016/j.amjsurg.2022.09.057

Abstract

Background: Severe pelvic fracture is the most common indication for resuscitative endovascular balloon occlusion of the aorta (REBOA). This matched cohort study investigated outcomes with or without REBOA use in isolated severe pelvic fractures.

Methods: Trauma Quality Improvement Program database study, included patients with isolated severe pelvic fracture (AIS≥3), excluded associated injuries with AIS >3 for any region other than lower extremity. REBOA patients were propensity score matched to similar patients without REBOA. Outcomes were mortality and complications.

Results: 93 REBOA patients were matched with 279 without. REBOA patients had higher rates of in-hospital mortality (32.3% vs 19%, p = 0.008), higher rates of venous thromboembolism (14% vs 6.5%, p = 0.023) and DVT (11.8% vs 5.4%, p = 0.035). In multivariate analysis, REBOA use was independently associated with increased mortality and venous thromboembolism.

Conclusions: REBOA in severe pelvic fractures is associated with higher rates of mortality, venous thromboembolism.

Keywords: Pelvic fractures; REBOA; Worse outcomes.

MeSH terms

Aorta
Balloon Occlusion*
Cohort Studies
Endovascular Procedures*
Fractures, Bone* / complications
Fractures, Bone* / therapy
Humans
Injury Severity Score
Resuscitation / adverse effects
Retrospective Studies
Shock, Hemorrhagic* / etiology
Shock, Hemorrhagic* / therapy
Venous Thromboembolism* / etiology