Resuscitative Endovascular Balloon Occlusion of the Aorta: Assessing Need in an Urban Trauma Center. J Surg Res 2019 Jan;233:413-419
Date
12/07/2018Pubmed ID
30502280Pubmed Central ID
PMC6713903DOI
10.1016/j.jss.2018.08.031Scopus ID
2-s2.0-85053469824 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a bridge to definitive hemostasis in select patients with noncompressible torso hemorrhage. The number of patients who might benefit from this procedure, however, remains incompletely defined. We hypothesized that we could quantify the number of patients presenting to our center over a 2-year period who may have benefited from REBOA.
METHODS: All patients presenting to our trauma center from 2014 to 2015 were included. Potential REBOA patients were identified based on anatomic injuries. We used ICD-9 codes to identify REBOA-amenable injury patterns and physiology. We excluded patients with injuries contraindicating REBOA. We then used chart review by two REBOA-experienced independent reviewers to assess each potential REBOA candidate, evaluate the accuracy of our algorithm, and to identify a cohort of confirmed REBOA candidates.
RESULTS: Four thousand eight hundred eighteen patients were included of which 666 had injuries potentially amenable to REBOA. Three hundred thirty-five patients were hemodynamically unstable, and 309 patients had contraindications to REBOA. Sixty-four patients had both injury patterns and physiology amenable to REBOA with no contraindications, and these patients were identified as potential REBOA candidates. Of these, detailed independent two physician chart review identified 29 patients (45%) as confirmed REBOA candidates (interrater reliability kappa = 0.94, P < 0.001).
CONCLUSIONS: Our database query identified patients with indications for REBOA but overestimated the number of REBOA candidates. To accurately quantify the REBOA candidate population at a given center, an algorithm to identify potential patients should be combined with chart review.
STUDY TYPE: Therapeutic study, level V.
Author List
Dumas RP, Holena DN, Smith BP, Jafari D, Seamon MJ, Reilly PM, Qasim Z, Cannon JWAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAorta
Balloon Occlusion
Endovascular Procedures
Health Services Needs and Demand
Hemorrhage
Hemostatic Techniques
Hospitals, Urban
Humans
Male
Middle Aged
Needs Assessment
Resuscitation
Retrospective Studies
Torso
Trauma Centers
Young Adult
