Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry

Federico Coccolini; Marco Ceresoli; David T. McGreevy; Mitra Sadeghi; Artai Pirouzram; Asko Toivola; Per Skoog; Koji Idoguchi; Yuri Kon; Tokiya Ishida; Yosuke Matsumura; Junichi Matsumoto; Viktor Reva; Mariusz Maszkowski; Paola Fugazzola; Matteo Tomasoni; Enrico Cicuttin; Luca Ansaloni; Claudia Zaghi; Maria Grazia Sibilla; Camilla Cremonini; Adam Bersztel; Eva Corina Caragounis; Mårten Falkenberg; Lauri Handolin; George Oosthuizen; Endre Szarka; Vassil Manchev; Tongporn Wannatoop; Sung Wook Chang; Boris Kessel; Dan Hebron; Gad Shaked; Miklosh Bala; Carlos A. Ordoñez; Peter Hibert-Carius; Massimo Chiarugi; Kristofer F. Nilsson; Thomas Larzon; Emiliano Gamberini; Vanni Agnoletti; Fausto Catena; Tal M. Hörer

doi:10.1007/s13304-020-00735-4

Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry

Federico Coccolini, Marco Ceresoli, David T. McGreevy, Mitra Sadeghi, Artai Pirouzram, Asko Toivola, Per Skoog, Koji Idoguchi, Yuri Kon, Tokiya Ishida, Yosuke Matsumura, Junichi Matsumoto, Viktor Reva, Mariusz Maszkowski, Paola Fugazzola, Matteo Tomasoni, Enrico Cicuttin, Luca Ansaloni, Claudia Zaghi, Maria Grazia SibillaCamilla Cremonini, Adam Bersztel, Eva Corina Caragounis, Mårten Falkenberg, Lauri Handolin, George Oosthuizen, Endre Szarka, Vassil Manchev, Tongporn Wannatoop, Sung Wook Chang, Boris Kessel, Dan Hebron, Gad Shaked, Miklosh Bala, Carlos A. Ordoñez, Peter Hibert-Carius, Massimo Chiarugi, Kristofer F. Nilsson, Thomas Larzon, Emiliano Gamberini, Vanni Agnoletti, Fausto Catena, Tal M. Hörer

Medical School for International Health

Research output: Contribution to journal › Article › peer-review

21 Scopus citations

Abstract

EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.

Original language	English
Pages (from-to)	527-536
Number of pages	10
Journal	Updates in Surgery
Volume	72
Issue number	2
DOIs	https://doi.org/10.1007/s13304-020-00735-4
State	Published - 1 Jun 2020

Keywords

ABO
EVTM
Hemodynamic
International
Morbidity
Mortality
Pelvis
REBOA
Registry
Trauma

ASJC Scopus subject areas

Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s13304-020-00735-4

Cite this

Coccolini, F., Ceresoli, M., McGreevy, D. T., Sadeghi, M., Pirouzram, A., Toivola, A., Skoog, P., Idoguchi, K., Kon, Y., Ishida, T., Matsumura, Y., Matsumoto, J., Reva, V., Maszkowski, M., Fugazzola, P., Tomasoni, M., Cicuttin, E., Ansaloni, L., Zaghi, C., ... Hörer, T. M. (2020). Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry. Updates in Surgery, 72(2), 527-536. https://doi.org/10.1007/s13304-020-00735-4

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title = "Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry",

abstract = "EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.",

keywords = "ABO, EVTM, Hemodynamic, International, Morbidity, Mortality, Pelvis, REBOA, Registry, Trauma",

author = "Federico Coccolini and Marco Ceresoli and McGreevy, {David T.} and Mitra Sadeghi and Artai Pirouzram and Asko Toivola and Per Skoog and Koji Idoguchi and Yuri Kon and Tokiya Ishida and Yosuke Matsumura and Junichi Matsumoto and Viktor Reva and Mariusz Maszkowski and Paola Fugazzola and Matteo Tomasoni and Enrico Cicuttin and Luca Ansaloni and Claudia Zaghi and Sibilla, {Maria Grazia} and Camilla Cremonini and Adam Bersztel and Caragounis, {Eva Corina} and M{\aa}rten Falkenberg and Lauri Handolin and George Oosthuizen and Endre Szarka and Vassil Manchev and Tongporn Wannatoop and Chang, {Sung Wook} and Boris Kessel and Dan Hebron and Gad Shaked and Miklosh Bala and Ordo{\~n}ez, {Carlos A.} and Peter Hibert-Carius and Massimo Chiarugi and Nilsson, {Kristofer F.} and Thomas Larzon and Emiliano Gamberini and Vanni Agnoletti and Fausto Catena and H{\"o}rer, {Tal M.}",

note = "Publisher Copyright: {\textcopyright} 2020, Italian Society of Surgery (SIC).",

year = "2020",

month = jun,

day = "1",

doi = "10.1007/s13304-020-00735-4",

language = "English",

volume = "72",

pages = "527--536",

journal = "Updates in Surgery",

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Coccolini, F, Ceresoli, M, McGreevy, DT, Sadeghi, M, Pirouzram, A, Toivola, A, Skoog, P, Idoguchi, K, Kon, Y, Ishida, T, Matsumura, Y, Matsumoto, J, Reva, V, Maszkowski, M, Fugazzola, P, Tomasoni, M, Cicuttin, E, Ansaloni, L, Zaghi, C, Sibilla, MG, Cremonini, C, Bersztel, A, Caragounis, EC, Falkenberg, M, Handolin, L, Oosthuizen, G, Szarka, E, Manchev, V, Wannatoop, T, Chang, SW, Kessel, B, Hebron, D, Shaked, G, Bala, M, Ordoñez, CA, Hibert-Carius, P, Chiarugi, M, Nilsson, KF, Larzon, T, Gamberini, E, Agnoletti, V, Catena, F & Hörer, TM 2020, 'Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry', Updates in Surgery, vol. 72, no. 2, pp. 527-536. https://doi.org/10.1007/s13304-020-00735-4

TY - JOUR

T1 - Aortic balloon occlusion (REBOA) in pelvic ring injuries

T2 - preliminary results of the ABO Trauma Registry

AU - Coccolini, Federico

AU - Ceresoli, Marco

AU - McGreevy, David T.

AU - Sadeghi, Mitra

AU - Pirouzram, Artai

AU - Toivola, Asko

AU - Skoog, Per

AU - Idoguchi, Koji

AU - Kon, Yuri

AU - Ishida, Tokiya

AU - Matsumura, Yosuke

AU - Matsumoto, Junichi

AU - Reva, Viktor

AU - Maszkowski, Mariusz

AU - Fugazzola, Paola

AU - Tomasoni, Matteo

AU - Cicuttin, Enrico

AU - Ansaloni, Luca

AU - Zaghi, Claudia

AU - Sibilla, Maria Grazia

AU - Cremonini, Camilla

AU - Bersztel, Adam

AU - Caragounis, Eva Corina

AU - Falkenberg, Mårten

AU - Handolin, Lauri

AU - Oosthuizen, George

AU - Szarka, Endre

AU - Manchev, Vassil

AU - Wannatoop, Tongporn

AU - Chang, Sung Wook

AU - Kessel, Boris

AU - Hebron, Dan

AU - Shaked, Gad

AU - Bala, Miklosh

AU - Ordoñez, Carlos A.

AU - Hibert-Carius, Peter

AU - Chiarugi, Massimo

AU - Nilsson, Kristofer F.

AU - Larzon, Thomas

AU - Gamberini, Emiliano

AU - Agnoletti, Vanni

AU - Catena, Fausto

AU - Hörer, Tal M.

PY - 2020/6/1

Y1 - 2020/6/1

N2 - EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.

AB - EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24 h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24 h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications.

KW - ABO

KW - EVTM

KW - Hemodynamic

KW - International

KW - Morbidity

KW - Mortality

KW - Pelvis

KW - REBOA

KW - Registry

KW - Trauma

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U2 - 10.1007/s13304-020-00735-4

DO - 10.1007/s13304-020-00735-4

M3 - Article

C2 - 32130669

AN - SCOPUS:85080985073

SN - 2038-131X

VL - 72

SP - 527

EP - 536

JO - Updates in Surgery

JF - Updates in Surgery

IS - 2

ER -

Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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