REBOA Use and Complications in Geriatric Trauma Patients: Insights From a Multicenter Database

Resuscitative endovascular balloon occlusion of the aorta (REBOA) usage in the geriatric population has not been well studied. This study aimed to define REBOA use and complications in the geriatric population. It was hypothesized that geriatric patients may have greater rates of complications compared to younger patients due to geriatric patients having a greater likelihood of preexisting comorbidities.

Using the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry database, adult trauma patients were stratified by age (18-64 y versus ≥ 65 y). Data collected included demographic information, injury severity score (ISS), mechanism of injury, zone of placement, length of occlusion, development of acute kidney injury, and access site complications. Univariate analyses were performed with P value < 0.05 considered to be significant.

Of the 1156 patients, 157 (13.6%) were geriatric. There was no significant difference in ISS with both groups having a median ISS of 34 (interquartile range [IQR] 22, 43), P = 0.98. The distribution of REBOA zone placement was similar for both groups. The time of occlusion was not significantly different with geriatric median of 30 min (IQR 11,47) and nongeriatric median of 33 min (IQR 21, 60), P = 0.18. There was no significant difference in the rate of acute kidney injury (21.7% geriatric versus 22.1% nongeriatric, P = 1.0). There was a significantly lower rate of extremity ischemia (0% geriatric versus 3.7% nongeriatric, P = 0.006). There was no significant difference in rates of hematoma, arteriovenous fistula, stenosis, pseudoaneurysm, or distal embolism.

Age greater than or equal to 65 y was associated with a significantly lower rate of extremity limb ischemia. This difference could be due to preexisting comorbidities in this patient population. Future prospective studies are needed to further study this phenomenon.