Introduction
Methods
Registry overview
Ethical permission and data security
Data collection
Data analysis
Results
Registry overview
All | Survivors | Fatalities |
P
| |
---|---|---|---|---|
N
| 96 | 41 | 55 | |
Demography | ||||
Age/years (total = 84) | 52 ± 22 | 51 ± 20 | 54 ± 23 | 0.280 |
Age <60 years n (%) (total = 49) | 49 (58%) | 25 (64%) | 24 (53%) | 0.318 |
Age >60 years n (%) (total = 35) | 35 (42%) | 14 (36%) | 21 (47%) | |
Male/n (%) (total = 96) | 65 (68%) | 29 (69%) | 36 (67%) | 0.805 |
Pre-morbid health (total = 58) | ||||
Co-morbid n (%) | 27 (47%) | 15 (60%) | 12 (36%) | 0.074 |
No co-morbidity n (%) | 31 (53%) | 10 (30%) | 21 (64%) | |
Injury mechanism (total = 95) | ||||
Blunt/n (%) | 84 (88%) | 35 (85%) | 49 (91%) | 0.257 |
Penetrating/n (%) | 9 (10%) | 4 (10%) | 5 (9%) | |
Mixed/n (%) | 2 (2%) | 2 (5%) | 0 (0%) | |
Injury pattern and location | ||||
ISS/median IQR (total = 82) | 41 (29–50) | 34 (20–42) | 41 (34–51) | 0.001 |
Thorax/n (%) (total = 96) | 25 (26%) | 4 (10%) | 21 (39%) | 0.001 |
Abdomen/n (%) (total = 96) | 57 (59%) | 26 (62%) | 31 (57%) | 0.656 |
Pelvis/n (%) (total = 96) | 44 (46%) | 19 (45%) | 25 (46%) | 0.918 |
Head injury/n (%) (total = 91) | 36 (40%) | 12 (30%) | 24 (47%) | 0.099 |
Pre-hospital data | ||||
CPR/n (%) (total = 91) | 18 (20%) | 5 (13%) | 13 (25%) | 0.149 |
SBP <80 mmHg/n (%) (total = 50) | 29 (58%) | 10 (46%) | 19 (68%) | 0.111 |
SBP >80 mmHg/n (%) (total = 50) | 21 (42%) | 12 (55%) | 9 (32%) | |
GCS <8/n (%) (total = 75) | 28 (37%) | 7 (24%) | 21 (46%) | 0.061 |
GCS >8/n (%) (total = 75) | 47 (63%) | 22 (76%) | 25 (54%) | |
Emergency department data | ||||
CPR/n (%) (total = 79) | 11 (14%) | 3 (9%) | 8 (18%) | 0.220 |
SBP <80 mmHg/n (%) (total = 65) | 43 (66%) | 19 (60%) | 24 (73%) | 0.255 |
SBP >80 mmHg/n (%) (total = 65) | 22 (34%) | 13 (41%) | 9 (27%) | |
Laboratory data on admission | ||||
Hb/g/L/mean Std (total = 85) | 10.0 ± 2.4 | 10.4 ± 2.3 | 9.6 ± 2.5 | 0.211 |
pH/median IQR (total = 76) | 7.20 (7.05–7.34) | 7.30 (7.14–7.39) | 7.13 (6.99–7.27) | 0.001 |
Base deficit/mean Std (total = 46) | −11.0 ± 9.3 | −9.0 ± 5.7 | −12.8 ± 11.6 | 0.038 |
Lactate/mmol/l/median IQR (total = 45) | 8.1 (4.3–13.8) | 6.6 (3.4–9.9) | 10.6 (5.6–15.0) | 0.066 |
INR/median IQR (total = 51) | 1.3 (1.2–1.7) | 1.2 (1.1–1.4) | 1.5 (1.3–2.4) | 0.001 |
Patient characteristics, injury patterns and admission physiology
All | Survivors | Fatalities |
P
| |
---|---|---|---|---|
n
| 96 | 41 | 55 | |
Location of REBOA (total = 88) | ||||
Emergency room/n (%) | 58 (66%) | 24 (63%) | 34 (68%) | 0.608 |
Operating room/n (%) | 14 (16%) | 6 (16%) | 8 (16%) | |
Hybrid operating room/n (%) | 14 (16%) | 6 (16%) | 8 (16%) | |
Intensive care unit/n (%) | 1 (1%) | 1 (3%) | 0 | |
Other/n (%) | 1 (1%) | 1 (3%) | 0 | |
SBP | ||||
SBP before inflation/median IQR (total = 88) | 60 (40–80) | 70 (54–88) | 50 (0–74) | 0.006 |
SBP after inflation/median IQR (total = 89) | 100 (80–128) | 111(91–135) | 95 (65–125) | 0.029 |
Puncture technique (total = 85) | ||||
Landmark guided/n (%) | 71 (84%) | 34 (92%) | 37 (77%) | 0.073 |
Ultrasound guided/n (%) | 5 (6%) | 1 (3%) | 4 (8%) | |
Fluoroscopy guided/n (%) | 3 (3.5%) | 2 (5%) | 1 (2%) | |
Cut-down/n (%) | 6 (7%) | 0 | 6 (13%) | |
Specialty obtaining access (total = 90) | ||||
ED/ICU/n (%) | 60 (67%) | 29 (74%) | 31 (61%) | 0.405 |
Vascular surgeon/n (%) | 20 (22%) | 8 (21%) | 12 (24%) | |
General surgeon/n (%) | 3 (3%) | 0 | 3 (6%) | |
Radiologist/n (%) | 6 (7%) | 2 (5%) | 4 (8%) | |
Attempts at arterial access (total = 58) | ||||
1/n (%) | 32 (55%) | 13 (54%) | 19 (56%) | 0.526 |
2–3/n (%) | 21 (36%) | 10 (42%) | 11 (32%) | |
>3/n (%) | 5 (9%) | 1 (4%) | 4 (12%) | |
Zone of occlusion (total = 92) | ||||
Zone 1/n (%) | 86 (94%) | 37(93%) | 49 (94%) | 0.674 |
Zone 2/n (%) | 3 (3%) | 2 (5%) | 1 (2%) | |
Zone 3/n (%) | 3 (3%) | 1 (3%) | 2 (4%) | |
Total occlusion time (total = 73) [min/n (%)] | ||||
<30 | 26 (36%) | 15 (48%) | 11 (26%) | 0.147 |
31–60 | 26 (36%) | 9 (29%) | 17 (41%) | |
>60 | 21 (29%) | 7 (23%) | 14 (33%) | |
<40 | 38 (52%) | 19 (61%) | 19 (45%) | 0.175 |
>40 | 35 (48%) | 12 (39%) | 23 (55%) | |
Complications | ||||
Balloon migration/n (%) (total = 90) | 4 (4%) | 3 (8%) | 1 (2%) | 0.208 |
Balloon rupture/n (%) (total = 90) | 3 (3%) | 1 (3%) | 2 (4%) | 0.751 |
Extremity compartment syndrome/n (%) (total = 42) | 3 (7%) | 3 (19%) | 0 | 0.022 |
Signs of embolization/n (total = 85) | 3 (4%) | 1 (3%) | 2 (4%) | 0.657 |
Aortic/iliac rupture/n (total = 61) | 0 | 0 | 0 | |
Access site bleeding/n (total = 82) | 0 | 0 | 0 |
Methods and location of arterial access
REBOA procedure
Methods of definitive hemostasis, resuscitation and critical care
All | Survivors | Fatalities |
P
| |
---|---|---|---|---|
n
| 96 | 41 | 55 | |
Disposal from ED (total = 96) | ||||
Operating room/n (%) | 25 (26%) | 10 (24%) | 15 (28%) | 0.839 |
CT/n (%) | 10 (10%) | 6 (14%) | 4 (7%) | |
Angio suite/n (%) | 4 (4%) | 1 (2%) | 3 (6%) | |
ICU/n (%) | 2 (2%) | 1 (2%) | 1 (2%) | |
Hybrid operating room/n (%) | 12 (13%) | 6 (14%) | 6 (11%) | |
Hemorrhage control intervention | ||||
Laparotomy/n (%) (total = 96) | 44 (46%) | 23 (55%) | 21 (39%) | 0.122 |
Thoracotomy/n (%) (total = 84) | 29 (35%) | 3 (9%) | 26 (53%) | <0.001 |
Angioembolization/n (%) (total = 93) | 42 (45%) | 20 (48%) | 22 (43%) | 0.666 |
Pelvic external-fixation/n (%) (total = 51) | 25 (49%) | 13 (54%) | 12 (44%) | 0.488 |
Brain surgery/n (%) (total = 15) | 15 (100%) | 3 (20%) | 12 (80%) | |
No intervention/n (%) (total = 96) | 9 (9%) | 3 (7%) | 6 (11%) | 0.508 |
Resuscitation | ||||
PRBC/median IQR (total = 81) | 7 (3–14) | 8 (4–12) | 6 (2–14) | 0.554 |
FFP/median IQR (total = 79) | 8 (4–13) | 8 (4–17) | 8 (4–12) | 0.413 |
PLT/median IQR (total = 74) | 1 (0–2) | 2 (1–2) | 1 (0–2) | 0.052 |
ICU care | ||||
Days/median IQR (total = 73) | 1 (0–5) | 5 (2–7) | 0 (0–1) | <0.001 |
Multiple organ failure/n (%) (total = 29) | 10 (35%) | 2 (18%) | 8 (44%) | 0.149 |
30-day mortality | ||||
n (%) (total = 96) | 54 (56%) | 0 |
Continuous vs. non-continuous occlusion and complications
Continuous REBOA | Non-continuous REBOA |
P
| |
---|---|---|---|
n | 50 | 46 | |
Demography | |||
Male/n (%) (total = 96) | 35 (70%) | 30 (65%) | 0.617 |
Age/mean Std (total = 84) | 54 ± 25 | 51 ± 18 | 0.403 |
Mechanism of injury (total = 95) | |||
Blunt/n (%) | 42 (86%) | 42 (91%) | 0.365 |
Penetrating/n (%) | 5 (10%) | 4 (9%) | |
ISS | |||
Median (IQR) (total = 82) | 41 (30–54) | 38 (26-50) | 0.255 |
Occlusion Time (total = 73) [min/n (%)] | |||
<30 | 13 (46%) | 13 (29%) | 0.083 |
31–60 | 11 (39%) | 15 (33%) | |
>60 | 4 (14%) | 17 (38%) | |
Pre-hospital data | |||
GCS < 8/n (%) (total = 75) | 13 (41%) | 15 (35%) | 0.611 |
CPR/n (%) (total = 91) | 11 (23%) | 7 (16%) | 0.370 |
Systolic blood pressure | |||
ED Admission < 80 mmHg/n (%) (total = 65) | 22 (67%) | 21 (66%) | 0.929 |
SBP mm Hg before inflation/median (IQR) (total = 88) | 50 (0–70) | 68 (43–88) | 0.026 |
SBP mmHg after inflation/median (IQR) (total = 89) | 95 (69–120) | 110 (90–135) | 0.022 |
Laboratory data on admission | |||
ED Lactate/median (IQR) (total = 45) | 8.5 (4.2-13.0) | 7.4 (4.5–13.8) | 0.890 |
ED Base deficit/mean Std (total = 46) | −11.4 ± 10.0 | −10.3 ± 8.2 | 0.426 |
ED INR/median (IQR) (total = 51) | 1.4 (1.2–1.8) | 1.2 (1.1–1.6) | 0.078 |
Complications | |||
Extremity compartment syndrome/n (%) (total = 42) | 3 (11%) | 0.0 | 0.180 |
Balloon migration/n (%) (total = 90) | 1 (2%) | 3 (7%) | 0.285 |
Balloon rupture/n (%) (total = 90) | 1 (2%) | 2 (5%) | 0.531 |
Signs of embolization/n (%) (total = 85) | 2 (4%) | 1 (3%) | 0.628 |
MOF/n (MOF/total) (total = 29) | 6 (6/18) | 4 (4/11) | 0.868 |
Mortality | |||
n (%) (total = 96) | 32 (64%) | 22 (48%) | 0.111 |