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Worse outcomes with resuscitative endovascular balloon occlusion of the aorta in severe pelvic fracture: A matched cohort study

  • Chih-Ying Chien
    Affiliations
    Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States

    Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
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  • Meghan R. Lewis
    Affiliations
    Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States
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  • Joshua Dilday
    Affiliations
    Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States
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  • Subarna Biswas
    Affiliations
    Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States
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  • Yong Luo
    Affiliations
    Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States

    Trauma Center & Critical Care Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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  • Demetrios Demetriades
    Correspondence
    Corresponding author. USC School of Medicine Director of Trauma, Emergency Surgery, and Surgical Critical Care, LAC+USC Medical Center 2051 Marengo St, Los Angeles, CA, 90033, United States.
    Affiliations
    Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, United States
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Published:October 09, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.09.057

      Highlights

      REBOA in isolated severe pelvic fractures:
      • Worse mortality
      • Higher venous thromboembolic complications
      • More acute kidney injuries

      Abstract

      Background

      Severe pelvic fracture is the most common indication for resuscitative endovascular balloon occlusion of the aorta (REBOA). This matched cohort study investigated outcomes with or without REBOA use in isolated severe pelvic fractures.

      Methods

      Trauma Quality Improvement Program database study, included patients with isolated severe pelvic fracture (AIS≥3), excluded associated injuries with AIS >3 for any region other than lower extremity. REBOA patients were propensity score matched to similar patients without REBOA. Outcomes were mortality and complications.

      Results

      93 REBOA patients were matched with 279 without. REBOA patients had higher rates of in-hospital mortality (32.3% vs 19%, p = 0.008), higher rates of venous thromboembolism (14% vs 6.5%, p = 0.023) and DVT (11.8% vs 5.4%, p = 0.035). In multivariate analysis, REBOA use was independently associated with increased mortality and venous thromboembolism.

      Conclusions

      REBOA in severe pelvic fractures is associated with higher rates of mortality, venous thromboembolism.

      Graphical abstract

      Keywords

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