Resuscitative endovascular balloon occlusion of the aorta or resuscitative thoracotomy with aortic clamping for non-compressible torso hemorrhage: a retrospective nationwide study.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging treatment for non-compressible torso hemorrhage. It remains unclear if REBOA is superior to resuscitative thoracotomy with aortic cross-clamping (RT) in terms of improving outcomes. This study compared in-hospital outcomes between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock, using data from a national inpatient database in Japan. Methods: Using the Diagnosis Procedure Combination database, we identified patients who received REBOA or RT within 1 day after admission from 1 July 2010 to 31 March 2014. We excluded those with penetrating thoracic injuries. Propensity-score adjusted analyses were performed to compare in-hospital mortality, and other in-hospital outcomes. Results: Eligible patients (n = 259) were classified into the REBOA group (n = 191) or the RT group (n = 68). In the propensity-score-adjusted Cox regression analysis, the two groups did not differ significantly with respect to in-hospital mortality (hazard ratio, 0.94; 95% confidence interval, 0.60-1.48). There were also no significant differences between the groups in ventilator-free days, intensive-care-unit-free days, total amount of fluid infusion within 1 day after admission, total amount of transfusion within 1 day after admission, or total hospitalization costs. Conclusion: In this retrospective nationwide study, in-hospital outcomes were not significantly different between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock. Level of evidence: Therapeutic/Care management, level III (C) 2016 Lippincott Williams & Wilkins, Inc.

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