Predicting Success of REBOA: Timing supersedes variable techniques in predicting patient survival.

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REBOA is used for temporary aortic occlusion of trauma patients in the management of non-compressible hemorrhage. Previous studies have focused on how to properly perform REBOA in the trauma environment to improve survival rates, but high grade evidence defining the ideal patient population does not yet exist. This posthoc analysis of the Emergent Truncal Hemorrhage Control Study seeks to identify the most important clinical factors for physicians to consider when selecting for REBOA candidates and their potential survival following REBOA.Post hoc analysis of a large multicenter, prospective observational study conducted at six Level 1 Trauma centers, 2017-2018. An onsite data collector documented all timepoints for REBOA patients since admission. Candidate predictors were: demographics, injury severity, physiology pre, during and post procedure, CPR, REBOA-specific variables (time to procedure, procedure-related time intervals, access site, technique, sheath size, catheter length, balloon volume, deployment zone). Predictive models for survival at three different timepoints along the trauma triage and REBOA process timeline (“Admission”, “REBOA Initiation” and “Postaortic Occlusion”) were devised by logistic regression.88 patients had REBOA placement. The “Admission” model selected age, GCS, and admission SBP as significant predictors of survival (AUC 0.86; 95% CI 0.77-0.94). The “REBOA Initiation” and “After Aortic Occlusion” models selected age, GCS, and the SBP measured just prior to balloon inflation as predictors for survival (AUC 0.87 with 95% CI 0.78-0.97 and AUC as 0.90 with 95% CI 0.81-0.99, respectively). No REBOA procedural variables were identified as predictors of patient survival.Only patient-specific criteria of age, neurologic status, and severity of shock predicted survival. The hemodynamic stability of the patient at the time REBOA is initiated is more important than how REBOA is initiated. These findings suggest that earlier preparation for REBOA placement may be a key to improved survival.Level III Prospective Observational Study.

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Authors: Alexis L Cralley, Ernest E Moore, Thomas M Scalea, Kenji Inaba, Eileen M Bulger, David E Meyer, Charles J Fox, Angela Sauaia