1. Practice, Practice, Practice! Effect of Resuscitative Endovascular Balloon Occlusion of the Aorta Volume on Outcomes: Data From the AAST AORTA Registry.
- Author
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Theodorou CM, Anderson JE, Brenner M, Scalea TM, Inaba K, Cannon J, Seamon M, Spalding MC, Fox CJ, Moore EE, DuBose JJ, and Galante JM
- Subjects
- Adult, Aorta surgery, Balloon Occlusion adverse effects, Balloon Occlusion instrumentation, Cardiopulmonary Resuscitation adverse effects, Cardiopulmonary Resuscitation instrumentation, Cardiopulmonary Resuscitation methods, Education, Medical, Continuing organization & administration, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Endovascular Procedures methods, Female, Hemorrhage etiology, Hemorrhage mortality, Hospitals, High-Volume statistics & numerical data, Hospitals, Low-Volume organization & administration, Hospitals, Low-Volume statistics & numerical data, Humans, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Registries statistics & numerical data, Retrospective Studies, Surgeons education, Thoracic Injuries complications, Thoracic Injuries mortality, Treatment Outcome, Vascular Access Devices adverse effects, Young Adult, Balloon Occlusion methods, Cardiopulmonary Resuscitation education, Endovascular Procedures education, Hemorrhage therapy, Postoperative Complications prevention & control, Thoracic Injuries therapy
- Abstract
Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular adjunct to hemorrhage control. Success relies on institutional support and focused training in arterial access. We hypothesized that hospitals with higher REBOA volumes will be more successful than low-volume hospitals at aortic occlusion with REBOA., Methods: This is a retrospective study from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Registry from November 2013 to January 2018. Patients aged ≥18 y who underwent REBOA were included. Successful placement of REBOA catheters (defined as hemodynamic improvement with balloon inflation) was compared between high-volume (≥80 cases; two hospitals), mid-volume (10-20 cases; four hospitals), and low-volume (<10 cases; 14 hospitals) hospitals, adjusting for patient factors., Results: Of 271 patients from 20 hospitals, 210 patients (77.5%) had successful REBOA placement. Most patients were male (76.0%) and sustained blunt trauma (78.1%). cardiopulmonary resuscitation (CPR) was ongoing at the time of REBOA placement in 34.5% of patients. Inpatient mortality was 67.4%, unchanged by hospital volume. Multivariable logistic regression found increased odds of successful REBOA placement at high-volume versus low-volume hospitals (odds ratio [OR], 7.50; 95% confidence interval [CI], 2.10-27.29; P = 0.002) and mid-volume versus low-volume hospitals (OR, 7.82; 95% CI, 1.52-40.31; P = 0.014) and decreased odds among patients undergoing CPR during REBOA placement (OR, 0.10; 95% CI, 0.03-0.34; P < 0.001) when adjusting for age, sex, mechanism of injury, prehospital CPR, CPR on admission, transfer status, hospital location of REBOA placement, Glasgow Coma Scale ≤ 13, and injury severity., Conclusions: Hospitals with higher REBOA volumes were more likely to achieve hemodynamic improvement with REBOA inflation. However, mortality and complication rates were unchanged. Independent of hospital volume, ongoing CPR is associated with a decreased odds of successful REBOA placement., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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