To Ultrasound or not to Ultrasound: A REBOA Femoral Access Analysis from the ABOTrauma and AORTA Registries
Keywords:Resuscitative balloon occlusion of the aorta; femoral artery; arterial access; non-compressible torso hemorrhage
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized
adjunct in the management of non-compressible hemorrhage. Ultrasound (US)-guided femoral
access has been taught as the best practice for femoral artery cannulation. However, there is lack
of evidence to support its use in patients in extremis with severe hemorrhage. We hypothesize
that no differences in outcome will exist between US-guided in comparison to blind
percutaneous or cutdown access methods.
This was an international, multicenter retrospective review of all patients managed with REBOA
from the ABOTrauma Registry and the AORTA database. REBOA characteristics and outcomes
were compared among puncture access methods. Significance was set at P < 0.05.
The cohort included 523 patients, primarily male (74%), blunt injured (77%) with median age 40
(27 – 58), ISS 34 (25 – 45). Percutaneous using external landmarks/palpation was the most
common femoral puncture method (53%) used followed by US-guided (27.9%). There was no
significant difference in overall complication rates (37.4% vs 34.9%; P = 0.615) or mortality
(47.8% vs 50.3%; P = 0.599) between percutaneous and US-guided methods; however, access by
cutdown was significantly associated with emergency department (ED) mortality (P = 0.004), 24
hour mortality (P = 0.002), and in-hospital mortality (P = 0.007).
In patients with severe hemorrhage in need of REBOA placement, the percutaneous approach
using anatomic landmarks and palpation, when compared to ultrasound-guided femoral access,
was used more frequently without an increase in complications, access attempts, or mortality.
Surgical cutdown was associated with highest ED, 24-hour, and in-hospital mortality.
Level of Evidence: Level III; Prognostic