A Comparative Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), Resuscitative Thoracotomy, and Nonprocedural Care for the Management of Life-Threatening Traumatic Torso Hemorrhage.

Objective: This study aimed to compare the mortality of resuscitative endovascular balloon occlusion of the aorta (REBOA) with emergency department thoracotomy (EDT) and nonprocedural resuscitation (NPR) in the initial resuscitation of life-threatening acute traumatic hemorrhage.

Methods: We performed a retrospective chart review of all patients who presented at a single urban level I trauma center with noncompressible torso hemorrhage between January 1, 2012, and October 31, 2022. Patients with a life-threatening injury (Abbreviated Injury Scale score >3) involving significant bleeding in the thorax or abdomen were included. Exclusion criteria were life-threatening head injury and mechanism of ground-level fall. Patients were classified according to the primary means of resuscitation: EDT, REBOA, or blood products and fluid (hemostatic resuscitation) without procedural intervention. The primary outcome was in-hospital mortality. Univariate and multivariate analyses were performed. Covariates included patient demographics, mechanism of injury, and injury severity.

Results: Two hundred sixty-seven cases met the criteria for inclusion. Initial resuscitation was EDT for 71 patients, REBOA for 17, and hemostatic resuscitation only for 179. Mortality rates for EDT compared to REBOA were 64 (90.1%) vs. 10 (58.8%) (p = 0.0051). The adjusted odds ratio (OR) was 0.09 (p = 0.009). The mortality rate for hemostatic resuscitation alone was 41 (22.9%) (p < 0.001) with an OR of 0.02 compared with those who received either EDT or REBOA. This finding remained significant when REBOA and conservative management were compared directly, excluding EDT patients (p = 0.0033).

Conclusions: Mortality associated with EDT is higher than that of REBOA. Mortality for both is higher than nonprocedural hemostatic resuscitation. REBOA is an appropriate salvage maneuver for patients with life-threatening abdominopelvic hemorrhage. However, our results do not support liberalizing its indications to patients responsive to hemostatic resuscitation.