Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Exsanguinating Subdiaphragmatic Hemorrhage
Authors' conclusion
In this study, prehospital Z1 P-REBOA is feasible and may enable early survival, but with a significant incidence of late death.
Study context
- Population
- Adult trauma patients (≥16 years) with suspected exsanguinating subdiaphragmatic hemorrhage and recent or imminent hypovolemic traumatic cardiac arrest (TCA), physician-led urban prehospital trauma service, Greater Londonof 2960 attended
- Participants
- 16 patients
- Outcome
- Proportion of patients in whom Z1 REBOA and Z1 P-REBOA were achieved
Methodological detailsIDEAL 2A design, single prehospital trauma service, Recruitment June 2020 to March 2022; follow-up until discharge, death, or 90 days
- IDEAL 2A design
- Single prehospital trauma service
- Recruitment June 2020 to March 2022; follow-up until discharge, death, or 90 days
Main finding
As reported in the abstract
Proportion achieving Z1 REBOA and Z1 P-REBOA
- Femoral arterial access attempted
- 16
- REBOA not attempted after successful access because clinical condition improved
- 2
- Successful cannulation with aortic balloon inflated in Z1, of the remaining 14 (8 [57%] in TCA)
- 11
- Cannulation failure rate (all 3 failures in TCA)
- 3/14 [21%]
- P-REBOA feasible
- 8/11 [73%]
- P-REBOA occurred spontaneously, of the 8 with P-REBOA
- 4
Observational data: associations, not effects.
Further findings
Systolic blood pressure (SBP) response to Z1 REBOA plus P-REBOA (11 successfully cannulated, 5 [46%] in TCA)
- Pre-REBOA SBP, median (IQR)
- 47 (33-52) mm Hg
- SBP at ED arrival, median [IQR]
- 101 [77-107] mm Hg
- Patients in TCA at ED arrival
- 0 of 10
- Median group-level improvement in SBP from pre-REBOA value
- 52 (95% CI, 42-77) mm Hg (P < .004)
Mortality postinjury
- 1- and 3-hour mortality
- 9% (1/11)
- 24-hour mortality
- 27% (3/11)
- 30-day mortality
- 82% (9/11)
Survival to hospital discharge
- Survival to hospital discharge
- 18% (2/11)
- Both survivors underwent early Z1 P-REBOA
Original publication
Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Exsanguinating Subdiaphragmatic Hemorrhage. JAMA Surg. Published 1 September 2024. doi:10.
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