AORTA Registry 7F vs 11-12 F access

AORTA registry access size

Authors

  • Reviewer Joseph DuBose USUHS
  • Jonathan Morrison R Adams Cowley Shock Trauma Center, University of Maryland Medical System
  • Megan Brenner Riverside Medical Center
  • Laura Moore University of Texas - Houston
  • John B Holcomb University of Texas - Houston
  • Kenji Inaba University of Southern California
  • Jeremy Cannon University of Pennsylvania
  • Mark Seamon University of Pennsylvania
  • David Skarupa University of Florida - Jacksonville
  • Ernest Moore Denver General Hospital
  • Charles Fox Denver General Hospital
  • Joseph Ibrahim Orlando Regional Medical Center
  • Tom Scalea R Adams Cowley Shock Trauma Center University of Maryland Medical System

DOI:

https://doi.org/10.26676/jevtm.v3i1.79

Keywords:

REBOA, trauma, aortic occlusion, injury, hemorrhage

Abstract

ABSTRACT

Introduction:  The introduction of low profile devices designed for Resuscitative

Endovascular Balloon Occlusion of the Aorta (REBOA) after trauma has the potential to

change practice, outcomes and complication profiles related to this procedure.

Methods: The AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care

Surgery (AORTA) registry was utilized to identify REBOA patients from 16 centers

-comparing presentation, intervention and outcome variables for those REBOA via

traditional 11-12 access platforms and trauma-specific devices requiring only 7 F access.

Results:From Nov 2013-Dec 2017, 242 patients with completed data were identified,

constituting 124 7F and 118 11-12F uses. Demographics of presentation were not

different between the two groups, except that the 7F patients had a higher mean ISS (39.2

  1. 34.1, p = 0.028). 7F device use was associated with a lower cut-down requirement for

access (22.6% vs. 37.3%, p = 0.049) and increased ultrasound guidance utilization (29.0%

  1. 23.7%, p = 0.049). 7F device afforded earlier aortic occlusion in the course of

resuscitation (median 25.0 mins vs. 30 mins, p = 0.010), and had lower median PRBC

(10.0 vs. 15.5 units, p = 0.006) and FFP requirements (7.5 vs. 14.0 units, p = 0.005). 7F

patients were more likely to survive 24 hrs (58.1% vs. 42.4%, p = 0.015) and less likely

to suffer in-hospital mortality (57.3% vs. 75.4%, p = 0.003). Finally, 7F device use was

associated with a 4X lower rate of distal extremity embolism (20.0% vs. 5.6%, p =

0.014;OR 95% CI 4.25 [1.25-14.45]) compared to 11-12F counterparts.

Conclusion: The introduction of trauma specific 7F REBOA devices appears to have

influenced REBOA practices, with earlier utilization in severely injured hypotensive

patients via less invasive means that are associated with lower transfusion requirements

fewer thrombotic complications and improved survival. Additional study is required to determine optimal REBOA

utilization.

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Published

2019-01-21

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Original Article