Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

Ramiro Manzano-Nunez; David McGreevy; Claudia P. Orlas; Alberto F. Garciá; Tal M. Hörer; Joseph Dubose; Carlos A. Ordoñez; Jonny Morrison; Thomas M. Scalea; Laura J. Moore; Jeanette M. Podbielski; John B. Holcomb; Kenji Inaba; Alice Piccinini; David S. Kauvar; Valorie L. Baggenstoss; Catherine Rauschendorfer; Jeremey Cannon; Mark Seamon; Ryan Dumas; Mike Vella; Jessica Guzman; Chance Spalding; Timothy W. Wolff; Chuck Fox; Ernest Moore; David Turay; Cassra N. Arbabi; Xian Luo-Owen; David Skarupa; Jennifer A. Mull; Joannis Baez Gonzalez; Joseph Ibrahim; Karen Safcsak; Stephanie Gordy; Michael Long; Andrew W. Kirkpatrick; Chad G. Ball; Zhengwen Xiao; Elizabeth Dauer; Jennifer Knight; Nicole Cornell; Forrest Dell Moore; Matthew Bloom; Nam T. Tran; Eileen Bulger; Jeannette G. Ward; John K. Bini; John Matsuura; Joshua Pringle; Karen Herzing; Kailey Nolan; Nathaniel Poulin; William Teeter; Rachel Nygaard; Chad Richardson; Joseph Skaja; Derek Lombard; Reagan Bollig; Brian Daley; Niki Rasnake; Marko Bukur; Elizabeth Warnack; Joseph Farhat; Robert M. Madayag; Pamela Bourg; Anna Ramstedt; Mitra Sadeghi; Kristofer F. Nilsson; Thomas Larzon; Artai Pirouzram; Asko Toivola; Mariusz Maszkowski; Adam Bersztel; Per Skoog; Koji Idoguchi; Yuri Kon; Tokiya Ishida; Yosuke Matsumura; Junichi Matsumoto; Viktor Reva; Eva Corina Caragounis; Mårten Falkenberg; Lauri Handolin; George Oosthuizen; Endre Szarka; Vassil Manchev; Tongporn Wannatoop; Sung W. Chang; Boris Kessel; Dan Hebron; Gad Shaked; Miklosh Bala; Federico Coccolini; Luca Ansaloni; Peter Hibert-Carius; Michelle Moe; Suzanne Maria Vrancken

doi:10.1186/s13017-020-00337-w

Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

Ramiro Manzano-Nunez, David McGreevy, Claudia P. Orlas, Alberto F. Garciá, Tal M. Hörer, Joseph Dubose, Carlos A. Ordoñez, Jonny Morrison, Thomas M. Scalea, Laura J. Moore, Jeanette M. Podbielski, John B. Holcomb, Kenji Inaba, Alice Piccinini, David S. Kauvar, Valorie L. Baggenstoss, Catherine Rauschendorfer, Jeremey Cannon, Mark Seamon, Ryan DumasMike Vella, Jessica Guzman, Chance Spalding, Timothy W. Wolff, Chuck Fox, Ernest Moore, David Turay, Cassra N. Arbabi, Xian Luo-Owen, David Skarupa, Jennifer A. Mull, Joannis Baez Gonzalez, Joseph Ibrahim, Karen Safcsak, Stephanie Gordy, Michael Long, Andrew W. Kirkpatrick, Chad G. Ball, Zhengwen Xiao, Elizabeth Dauer, Jennifer Knight, Nicole Cornell, Forrest Dell Moore, Matthew Bloom, Nam T. Tran, Eileen Bulger, Jeannette G. Ward, John K. Bini, John Matsuura, Joshua Pringle, Karen Herzing, Kailey Nolan, Nathaniel Poulin, William Teeter, Rachel Nygaard, Chad Richardson, Joseph Skaja, Derek Lombard, Reagan Bollig, Brian Daley, Niki Rasnake, Marko Bukur, Elizabeth Warnack, Joseph Farhat, Robert M. Madayag, Pamela Bourg, Anna Ramstedt, Mitra Sadeghi, Kristofer F. Nilsson, Thomas Larzon, Artai Pirouzram, Asko Toivola, Mariusz Maszkowski, Adam Bersztel, Per Skoog, Koji Idoguchi, Yuri Kon, Tokiya Ishida, Yosuke Matsumura, Junichi Matsumoto, Viktor Reva, Eva Corina Caragounis, Mårten Falkenberg, Lauri Handolin, George Oosthuizen, Endre Szarka, Vassil Manchev, Tongporn Wannatoop, Sung W. Chang, Boris Kessel, Dan Hebron, Gad Shaked, Miklosh Bala, Federico Coccolini, Luca Ansaloni, Peter Hibert-Carius, Michelle Moe, Suzanne Maria Vrancken

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

7 Scopus citations

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results: A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36-1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63-3,33; p = 0.3). Conclusion: There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.

Original language	English (US)
Article number	57
Journal	World Journal of Emergency Surgery
Volume	15
Issue number	1
DOIs	https://doi.org/10.1186/s13017-020-00337-w
State	Published - Oct 12 2020

Keywords

Income of countries
REBOA
Trauma

ASJC Scopus subject areas

Surgery
Emergency Medicine

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10.1186/s13017-020-00337-w

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Manzano-Nunez, R., McGreevy, D., Orlas, C. P., Garciá, A. F., Hörer, T. M., Dubose, J., Ordoñez, C. A., Morrison, J., Scalea, T. M., Moore, L. J., Podbielski, J. M., Holcomb, J. B., Inaba, K., Piccinini, A., Kauvar, D. S., Baggenstoss, V. L., Rauschendorfer, C., Cannon, J., Seamon, M., ... Vrancken, S. M. (2020). Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries. World Journal of Emergency Surgery, 15(1), Article 57. https://doi.org/10.1186/s13017-020-00337-w

Manzano-Nunez, R, McGreevy, D, Orlas, CP, Garciá, AF, Hörer, TM, Dubose, J, Ordoñez, CA, Morrison, J, Scalea, TM, Moore, LJ, Podbielski, JM, Holcomb, JB, Inaba, K, Piccinini, A, Kauvar, DS, Baggenstoss, VL, Rauschendorfer, C, Cannon, J, Seamon, M, Dumas, R, Vella, M, Guzman, J, Spalding, C, Wolff, TW, Fox, C, Moore, E, Turay, D, Arbabi, CN, Luo-Owen, X, Skarupa, D, Mull, JA, Gonzalez, JB, Ibrahim, J, Safcsak, K, Gordy, S, Long, M, Kirkpatrick, AW, Ball, CG, Xiao, Z, Dauer, E, Knight, J, Cornell, N, Moore, FD, Bloom, M, Tran, NT, Bulger, E, Ward, JG, Bini, JK, Matsuura, J, Pringle, J, Herzing, K, Nolan, K, Poulin, N, Teeter, W, Nygaard, R, Richardson, C, Skaja, J, Lombard, D, Bollig, R, Daley, B, Rasnake, N, Bukur, M, Warnack, E, Farhat, J, Madayag, RM, Bourg, P, Ramstedt, A, Sadeghi, M, Nilsson, KF, Larzon, T, Pirouzram, A, Toivola, A, Maszkowski, M, Bersztel, A, Skoog, P, Idoguchi, K, Kon, Y, Ishida, T, Matsumura, Y, Matsumoto, J, Reva, V, Caragounis, EC, Falkenberg, M, Handolin, L, Oosthuizen, G, Szarka, E, Manchev, V, Wannatoop, T, Chang, SW, Kessel, B, Hebron, D, Shaked, G, Bala, M, Coccolini, F, Ansaloni, L, Hibert-Carius, P, Moe, M & Vrancken, SM 2020, 'Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries', World Journal of Emergency Surgery, vol. 15, no. 1, 57. https://doi.org/10.1186/s13017-020-00337-w

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title = "Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries",

abstract = "Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results: A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36-1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63-3,33; p = 0.3). Conclusion: There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.",

keywords = "Income of countries, REBOA, Trauma",

author = "Ramiro Manzano-Nunez and David McGreevy and Orlas, {Claudia P.} and Garci{\'a}, {Alberto F.} and H{\"o}rer, {Tal M.} and Joseph Dubose and Ordo{\~n}ez, {Carlos A.} and Jonny Morrison and Scalea, {Thomas M.} and Moore, {Laura J.} and Podbielski, {Jeanette M.} and Holcomb, {John B.} and Kenji Inaba and Alice Piccinini and Kauvar, {David S.} and Baggenstoss, {Valorie L.} and Catherine Rauschendorfer and Jeremey Cannon and Mark Seamon and Ryan Dumas and Mike Vella and Jessica Guzman and Chance Spalding and Wolff, {Timothy W.} and Chuck Fox and Ernest Moore and David Turay and Arbabi, {Cassra N.} and Xian Luo-Owen and David Skarupa and Mull, {Jennifer A.} and Gonzalez, {Joannis Baez} and Joseph Ibrahim and Karen Safcsak and Stephanie Gordy and Michael Long and Kirkpatrick, {Andrew W.} and Ball, {Chad G.} and Zhengwen Xiao and Elizabeth Dauer and Jennifer Knight and Nicole Cornell and Moore, {Forrest Dell} and Matthew Bloom and Tran, {Nam T.} and Eileen Bulger and Ward, {Jeannette G.} and Bini, {John K.} and John Matsuura and Joshua Pringle and Karen Herzing and Kailey Nolan and Nathaniel Poulin and William Teeter and Rachel Nygaard and Chad Richardson and Joseph Skaja and Derek Lombard and Reagan Bollig and Brian Daley and Niki Rasnake and Marko Bukur and Elizabeth Warnack and Joseph Farhat and Madayag, {Robert M.} and Pamela Bourg and Anna Ramstedt and Mitra Sadeghi and Nilsson, {Kristofer F.} and Thomas Larzon and Artai Pirouzram and Asko Toivola and Mariusz Maszkowski and Adam Bersztel and Per Skoog and Koji Idoguchi and Yuri Kon and Tokiya Ishida and Yosuke Matsumura and Junichi Matsumoto and Viktor Reva 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 W.} and Boris Kessel and Dan Hebron and Gad Shaked and Miklosh Bala and Federico Coccolini and Luca Ansaloni and Peter Hibert-Carius and Michelle Moe and Vrancken, {Suzanne Maria}",

note = "Publisher Copyright: {\textcopyright} 2020 The Author(s).",

year = "2020",

month = oct,

day = "12",

doi = "10.1186/s13017-020-00337-w",

language = "English (US)",

volume = "15",

journal = "World Journal of Emergency Surgery",

issn = "1749-7922",

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number = "1",

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TY - JOUR

T1 - Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

AU - Manzano-Nunez, Ramiro

AU - McGreevy, David

AU - Orlas, Claudia P.

AU - Garciá, Alberto F.

AU - Hörer, Tal M.

AU - Dubose, Joseph

AU - Ordoñez, Carlos A.

AU - Morrison, Jonny

AU - Scalea, Thomas M.

AU - Moore, Laura J.

AU - Podbielski, Jeanette M.

AU - Holcomb, John B.

AU - Inaba, Kenji

AU - Piccinini, Alice

AU - Kauvar, David S.

AU - Baggenstoss, Valorie L.

AU - Rauschendorfer, Catherine

AU - Cannon, Jeremey

AU - Seamon, Mark

AU - Dumas, Ryan

AU - Vella, Mike

AU - Guzman, Jessica

AU - Spalding, Chance

AU - Wolff, Timothy W.

AU - Fox, Chuck

AU - Moore, Ernest

AU - Turay, David

AU - Arbabi, Cassra N.

AU - Luo-Owen, Xian

AU - Skarupa, David

AU - Mull, Jennifer A.

AU - Gonzalez, Joannis Baez

AU - Ibrahim, Joseph

AU - Safcsak, Karen

AU - Gordy, Stephanie

AU - Long, Michael

AU - Kirkpatrick, Andrew W.

AU - Ball, Chad G.

AU - Xiao, Zhengwen

AU - Dauer, Elizabeth

AU - Knight, Jennifer

AU - Cornell, Nicole

AU - Moore, Forrest Dell

AU - Bloom, Matthew

AU - Tran, Nam T.

AU - Bulger, Eileen

AU - Ward, Jeannette G.

AU - Bini, John K.

AU - Matsuura, John

AU - Pringle, Joshua

AU - Herzing, Karen

AU - Nolan, Kailey

AU - Poulin, Nathaniel

AU - Teeter, William

AU - Nygaard, Rachel

AU - Richardson, Chad

AU - Skaja, Joseph

AU - Lombard, Derek

AU - Bollig, Reagan

AU - Daley, Brian

AU - Rasnake, Niki

AU - Bukur, Marko

AU - Warnack, Elizabeth

AU - Farhat, Joseph

AU - Madayag, Robert M.

AU - Bourg, Pamela

AU - Ramstedt, Anna

AU - Sadeghi, Mitra

AU - Nilsson, Kristofer F.

AU - Larzon, Thomas

AU - Pirouzram, Artai

AU - Toivola, Asko

AU - Maszkowski, Mariusz

AU - Bersztel, Adam

AU - Skoog, Per

AU - Idoguchi, Koji

AU - Kon, Yuri

AU - Ishida, Tokiya

AU - Matsumura, Yosuke

AU - Matsumoto, Junichi

AU - Reva, Viktor

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 W.

AU - Kessel, Boris

AU - Hebron, Dan

AU - Shaked, Gad

AU - Bala, Miklosh

AU - Coccolini, Federico

AU - Ansaloni, Luca

AU - Hibert-Carius, Peter

AU - Moe, Michelle

AU - Vrancken, Suzanne Maria

PY - 2020/10/12

Y1 - 2020/10/12

N2 - Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results: A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36-1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63-3,33; p = 0.3). Conclusion: There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.

AB - Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results: A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36-1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63-3,33; p = 0.3). Conclusion: There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.

KW - Income of countries

KW - REBOA

KW - Trauma

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UR - http://www.scopus.com/inward/citedby.url?scp=85092509172&partnerID=8YFLogxK

U2 - 10.1186/s13017-020-00337-w

DO - 10.1186/s13017-020-00337-w

M3 - Article

C2 - 33046096

AN - SCOPUS:85092509172

SN - 1749-7922

VL - 15

JO - World Journal of Emergency Surgery

JF - World Journal of Emergency Surgery

IS - 1

M1 - 57

ER -

Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

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