Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma: A propensity score analysis
| Autor: | Atsushi Shiraishi, Junichi Inoue, Hiroki Matsui, Koichi Haruta, Ayako Yoshiyuki, Yasuhiro Otomo |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Resuscitation Thoracic Injuries Hemodynamics Aorta Thoracic Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Japan Predictive Value of Tests medicine.artery medicine Thoracic aorta Humans 030212 general & internal medicine Hospital Mortality Registries Aged Retrospective Studies Aorta business.industry Endovascular Procedures 030208 emergency & critical care medicine Retrospective cohort study Torso Middle Aged Surgery medicine.anatomical_structure Treatment Outcome Predictive value of tests Propensity score matching Female business |
| Zdroj: | The journal of trauma and acute care surgery. 80(4) |
| ISSN: | 2163-0763 |
| Popis: | Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a key procedure in early trauma care that provides hemorrhage control in hemodynamically unstable torso trauma patients. However, the clinical efficacy of REBOA remains uncertain. The objective of this study was to estimate the efficacy of REBOA in surgically treated severe torso trauma patients.We obtained data from the nationwide trauma registry in Japan (the Japan Trauma Data Bank) for trauma subjects who had undergone emergency surgery or transcatheter embolization against torso trauma. A logistic regression analysis estimated a propensity score to predict REBOA use from available predictors of in-hospital mortality. We then used a propensity score matching analysis to compare in-hospital mortality and door-to-primary surgery time in subjects who underwent REBOA and those who did not. In addition, we used an instrumental variable method to adjust for unmeasured confounding variables as a sensitivity analysis.Overall, 12,053 of the 183,457 trauma patients registered in the Japan Trauma Data Bank were eligible based on selection criteria. Propensity score matching selected 625 patients each for the with-REBOA and without-REBOA groups. The in-hospital mortality was significantly higher in subjects who underwent REBOA (61.8% vs. 45.3%; absolute difference, +16.5%; 95% confident interval, +10.9% to +22.0%). Door-to-primary surgery time was shorter in subjects who underwent REBOA than in those who did not (97 minutes vs. 110 minutes; absolute difference, -14 minutes; 95% confidence interval, -25 minutes to -3 minutes). The sensitivity analysis with the instrumental variable method did not alter the results and estimated nonsignificantly higher in-hospital mortality in REBOA subjects (+16.4%; 95% confidence interval, -0.6% to 33.3%).This study showed an association between the use of REBOA and excess mortality in patients with hemodynamically unstable torso trauma that had a median door-to-primary surgery time of 97 minutes. Further observational studies with detailed REBOA data are necessary to assess whether selected trauma subgroups could benefit from REBOA.Therapeutic study, level III. |
| Databáze: | OpenAIRE |
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