Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI)
Background The effects of aortic occlusion (AO) on brain injury are not well defined. We examined the impact of AO by resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative thoracotomy (RT) on outcomes in the setting of traumatic brain injury (TBI).Methods Patients susta...
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| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/7/1/e000715.full |
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| author | Raul Coimbra Megan Brenner John B Holcomb Jeanette Podbielski Kenji Inaba Thomas Scalea Mark Seamon Jonathan Morrison Chance Spalding Charles Fox Ernest E Moore Jeremy W Cannon Laura J Moore Bishoy Zakhary Joseph Abdellatif Ibrahim |
| author_facet | Raul Coimbra Megan Brenner John B Holcomb Jeanette Podbielski Kenji Inaba Thomas Scalea Mark Seamon Jonathan Morrison Chance Spalding Charles Fox Ernest E Moore Jeremy W Cannon Laura J Moore Bishoy Zakhary Joseph Abdellatif Ibrahim |
| author_sort | Raul Coimbra |
| collection | DOAJ |
| description | Background The effects of aortic occlusion (AO) on brain injury are not well defined. We examined the impact of AO by resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative thoracotomy (RT) on outcomes in the setting of traumatic brain injury (TBI).Methods Patients sustaining TBI who underwent RT or REBOA in zone 1 (thoracic aorta) from September 2013 to December 2018 were identified. The indication for REBOA or RT was hemodynamic collapse due to hemorrhage below the diaphragm. Primary outcomes included mortality and systemic complications.Results 282 patients underwent REBOA or RT. Of these, 76 had mild TBI (40 REBOA, 36 RT) and 206 sustained severe TBI (107 REBOA, 99 RT). Overall, the mean (±SD) age was 42±17 years, with an Injury Severity Score (ISS) of 40±17 and mean systolic blood pressure (SBP) at the time of REBOA or RT of 81±34 mm Hg. REBOA patients had a mean SBP at the time of AO of 78.39±29.45 mm Hg, whereas RT patients had a mean SBP of 83.18±37.87 mm Hg at the time of AO (p=0.24). 55% had ongoing cardiopulmonary resuscitation (CPR) at the time of AO, and the in-hospital mortality was 86%. Binomial logistic regression controlling for TBI severity, age, ISS, SBP at the time of AO, crystalloid infusion, and CPR during AO demonstrated that the odds of mortality are 3.1 times higher for RT compared with REBOA. No significant differences were found in systemic complications between RT and REBOA.Discussion Patients with TBI who receive REBOA may have improved survival, but no difference in systemic complications, compared with patients who receive RT for the same indication. Although some patients are receiving RT prior to arrest for extrathoracic hemorrhagic shock, these results suggest that REBOA should be considered as an alternative to RT when RT is chosen for the sole purpose of resuscitation in the setting of TBI.Level of evidence 4. |
| format | Article |
| id | doaj-art-a76ce72f4c2542dc8c9c8a5ac41be24d |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-a76ce72f4c2542dc8c9c8a5ac41be24d2024-11-30T07:30:12ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762022-10-017110.1136/tsaco-2021-000715Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI)Raul Coimbra0Megan Brenner1John B Holcomb2Jeanette Podbielski3Kenji Inaba4Thomas Scalea5Mark Seamon6Jonathan Morrison7Chance Spalding8Charles Fox9Ernest E Moore10Jeremy W Cannon11Laura J Moore12Bishoy Zakhary13Joseph Abdellatif Ibrahim14Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, California, USAUCLA Medical Center, Los Angeles, California, USAThe University of Alabama at Birmingham, Birmingham, Alabama, USASurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USATrauma and Acute Care Surgery, LAC USC Medical Center, Los Angeles, California, USATrauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USASurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USATrauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USATrauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USAVascular Surgery, Denver Health and Hospital Authority, Denver, Colorado, USAVascular Surgery, Denver Health and Hospital Authority, Denver, Colorado, USAPerelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USASurgery, University of Texas McGovern Medical School, Houston, Texas, USAComparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, California, USASurgery, Orlando Regional Medical Center, Orlando, Florida, USABackground The effects of aortic occlusion (AO) on brain injury are not well defined. We examined the impact of AO by resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative thoracotomy (RT) on outcomes in the setting of traumatic brain injury (TBI).Methods Patients sustaining TBI who underwent RT or REBOA in zone 1 (thoracic aorta) from September 2013 to December 2018 were identified. The indication for REBOA or RT was hemodynamic collapse due to hemorrhage below the diaphragm. Primary outcomes included mortality and systemic complications.Results 282 patients underwent REBOA or RT. Of these, 76 had mild TBI (40 REBOA, 36 RT) and 206 sustained severe TBI (107 REBOA, 99 RT). Overall, the mean (±SD) age was 42±17 years, with an Injury Severity Score (ISS) of 40±17 and mean systolic blood pressure (SBP) at the time of REBOA or RT of 81±34 mm Hg. REBOA patients had a mean SBP at the time of AO of 78.39±29.45 mm Hg, whereas RT patients had a mean SBP of 83.18±37.87 mm Hg at the time of AO (p=0.24). 55% had ongoing cardiopulmonary resuscitation (CPR) at the time of AO, and the in-hospital mortality was 86%. Binomial logistic regression controlling for TBI severity, age, ISS, SBP at the time of AO, crystalloid infusion, and CPR during AO demonstrated that the odds of mortality are 3.1 times higher for RT compared with REBOA. No significant differences were found in systemic complications between RT and REBOA.Discussion Patients with TBI who receive REBOA may have improved survival, but no difference in systemic complications, compared with patients who receive RT for the same indication. Although some patients are receiving RT prior to arrest for extrathoracic hemorrhagic shock, these results suggest that REBOA should be considered as an alternative to RT when RT is chosen for the sole purpose of resuscitation in the setting of TBI.Level of evidence 4.https://tsaco.bmj.com/content/7/1/e000715.full |
| spellingShingle | Raul Coimbra Megan Brenner John B Holcomb Jeanette Podbielski Kenji Inaba Thomas Scalea Mark Seamon Jonathan Morrison Chance Spalding Charles Fox Ernest E Moore Jeremy W Cannon Laura J Moore Bishoy Zakhary Joseph Abdellatif Ibrahim Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI) Trauma Surgery & Acute Care Open |
| title | Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI) |
| title_full | Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI) |
| title_fullStr | Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI) |
| title_full_unstemmed | Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI) |
| title_short | Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI) |
| title_sort | resuscitative endovascular balloon occlusion of the aorta reboa may be superior to resuscitative thoracotomy rt in patients with traumatic brain injury tbi |
| url | https://tsaco.bmj.com/content/7/1/e000715.full |
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