REBOA in shocked penetrating abdominal trauma patients: impact on outcomes.

Introduction: The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma is debated. We hypothesized that the use of REBOA for patients presenting in shock after penetrating abdominal trauma is associated with delay to laparotomy and increased mortality. Study design: We used 2017-2021 Trauma Quality Improvement Project data to identify adult (≥16 years) penetrating abdominal trauma patients with systolic blood pressure (SBP) ≤90 mm Hg undergoing laparotomy. REBOA was defined by International Classification of Diseases-10 code, with a procedure timestamp preceding or simultaneous to laparotomy incision. We propensity score matched REBOA to non-REBOA patients on demographics, mechanism, injury characteristics and severity, solid organ injury, abdominal vascular injury, SBP, heart rate, and Glasgow Coma Scale motor score. Outcomes were time to incision, transfusion requirements, complications, and in-hospital mortality. We additionally performed a survival analysis stratified by presenting SBP. Results: There were 148 REBOA patients with complete data for matching to 280 non-REBOA patients. Among patients with REBOA timestamps preceding laparotomy incision, there was a delay to laparotomy (time to incision 40 (31-50) vs 31 (24-43) min, p=0.001). Overall, REBOA was associated with increased transfusion volume (median (IQR) packed red blood cells 5,125 (2,100-9,100) vs 2,925 (1,250-5,500) ccs in the first 4 hours, p<0.001), leg amputations (3.4% vs 0.4%, p=0.010), and mortality (53.4% vs 42.5%, p=0.032). The mortality relationship persisted on 30-day survival analysis. Conclusion: REBOA for patients in shock after penetrating abdominal trauma is associated with delay to operation, greater transfusion requirement, leg amputation, and mortality. Our data support the need for expeditious definitive hemorrhage control in these patients. Level of evidence: III, retrospective cohort.