Pre-hospital time and mortality in patients who receive in-hospital resuscitative endovascular balloon occlusion of aorta (REBOA) : -a retrospective analysis using the ABOTrauma registry

Abstract: Introduction: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an endovascular technique for temporarily stabilizing hemodynamically unstable patients until permanent interventions can be performed. The benefits of in-hospital REBOA to control hemorrhage in different areas is now well studied, yet little is known about its use and indications in the pre-hospital setting. Aim: The aim of this study is to analyze if mortality amongst trauma patients who receive in-hospital REBOA is affected by total pre-hospital time (TPT) and if earlier prehospital REBOA intervention could be beneficial. Methods: A retrospective analysis using the ABOtrauma registry, an international registry for trauma patients that receive REBOA. There were 314 patients in the registry, 168 patients excluded because of missing data, wrong input, TPT < 15minuts or TPT > 120 minutes. The remaining 146 included were divided into 4 groups. Statistically analyzed using chi-square test for association or binomial logistic regression. Results: We found no significant correlation between TPT and mortality amongst the time groups that received in-hospital REBOA, at the emergency department (p=0.293), at 24 hours (p=0.209) or at 30 days (p=0.385), nor between time of injury and ABO insertion at 24 hours (p=0.917), or 30 days (p=0.840). Conclusion: Our findings suggests that pre-hospital time may not be a good indicator for survival amongst patients that receive in-hospital REBOA and that these patients might possibly have had a similar outcome even if earlier intervention of pre-hospital REBOA was performed. Future prospective randomized controlled trails on the subject is needed to draw certain conclusions.