REBOA or resuscitative thoracotomy, different tools for different patients. A real-life analysis from the AORTA...

Controversies remain about the decision to proceed to aortic occlusion (AO) using either REBOA or resuscitative thoracotomy (RT) in severely injured patients worldwide. Present study aims to identify and evaluate the differences in AO technique use related to patients' conditions.

This was a comparative study using a multicenter registry of postinjury AO (October 2013-February 2022). AO via REBOA was compared with RT performed in the emergency department of facilities experienced in both procedures and documented in Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry. Participants were adult trauma patients 16 years or older who experienced AO via REBOA zone 1 vs RT. The primary outcome was to identify the differences between patients treated with RT or REBOA. Ethical committee study approval number (Maryland IRB #HCR-HP-00,055,545-11).

1937 patients were included. Median age: 34 (25-49), 1599 (82.5 %) were men. Penetrating trauma: 52.4 %. REBOA was adopted in 501 (25.9 %) patients, RT in 1436 (74.1 %). Patients treated with REBOA were older (40vs32 years, p < 0.001), suffered more frequently blunt trauma (76.3 %vs37.7 %, p < 0.001) and had higher ISS (33vs26, p = 0.003). Fewer of them underwent prehospital cardio-pulmonary-resuscitation (23.2 %vs49.8 % p < 0.001); had higher median SBP and HR (83vs0, p < 0.001 and 106vs0, p < 0.001 respectively), serum lactate levels were lower (7.5vs10.3 p < 0.001). SBP≥ 60 mmHg pre-hospital and at-admission (OR 2.27) and GCS>8 at admission (OR 2.24), trauma cases admitted/year (>4000/year, OR 4.41), transfer from another trauma center (OR 1.94) were related to the use of REBOA. Higher Injury severity score (ISS >55, OR 0.66), lower number of trauma treated (<4000/year, OR 0.66) and penetrating trauma (OR 0.24) were related to the use of RT.

REBOA was more frequently used for older patients with blunt trauma, higher prehospital systolic blood pressure, and Glasgow Coma Scale scores above 8. RT was more commonly performed in penetrating trauma, lower injury severity scores, and facilities with fewer annual trauma admissions. These findings suggest that patient characteristics and institutional factors significantly differed between patients treated with REBOA or RT, underscoring the need for further research.