Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock
Authors' conclusion
Results of this comparative effectiveness research suggest that REBOA zone 1 provided better or similar survival than RT for patients requiring AO postinjury.
Study context
- Population
- Adult trauma patients 16 years or older requiring aortic occlusion (AO) for severe hemorrhagic shock, AORTA registry, October 2013 to September 2021
- Participants
- 991 patients · 56 propensity score matching (PSM) pairs
- Exposure
- AO via REBOA zone 1 vs resuscitative thoracotomy (RT) in the ED
- REBOAn = 306
- RTn = 685reference
- Outcome
- Survival
Methodological detailsmulticentre registry, propensity score matched, exact institution matching, multivariate analysis
- Multicentre registry
- Propensity score matched
- Exact institution matching
- Multivariate analysis
Main finding
As reported in the abstract
Mortality
P = 0.03
Observational data: associations, not effects.
Secondary outcomes
| Outcome | RR for survival (95% CI) | |
|---|---|---|
| Survival, multivariate analysis adjusted for significant confoundersREBOA zone 1 vs RT · confirmed survival benefit of REBOA zone 1 | 1.25 (1.15–1.36) | |
| 0.512RR for survival (log scale) |
| Outcome | RT | P value |
|---|---|---|
| VFD >0REBOA zone 1 vs RT · no significant difference · propensity-matched cohort | 7.1% | P = 0.07 |
| ICU-free days >0REBOA zone 1 vs RT · no significant difference · propensity-matched cohort | 7.1% | P = 0.08 |
| Discharge GOS ≥5REBOA zone 1 vs RT · no significant difference · propensity-matched cohort | 3.6% | P = 0.38 |
- VFD >0: REBOA zone 1 18.5%
- Intensive care unit (ICU)-free days >0: REBOA zone 1 18.2%
- Discharge Glasgow Outcome Score (GOS) ≥5: REBOA zone 1 7.5%
Survival in subgroups (CPR on arrival, TBI, chest injury, pelvic injury, blunt/penetrating mechanism, SBP ≤60 mm Hg on AO initiation)
- REBOA zone 1 offered either similar or superior survival in all subgroups
Original publication
Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock. JAMA Surg. Published 1 February 2023. doi:10.
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