Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture.

INTRODUCTION Pelvic hemorrhage is potentially lethal despite homeostatic interventions such as pre-peritoneal packing (PP), resuscitative endovascular balloon occlusion of the aorta (REBOA), surgery, and/or angioembolization. REBOA may be used as an alternative/adjunct to PP for temporizing bleeding in patients with pelvic fractures. Our study aims to compare the outcomes of REBOA and/or PP, as temporizing measures, in blunt pelvic fracture patients. We hypothesize that REBOA is associated with worsened outcomes. METHODS We performed a 2017 review of ACS-TQIP and identified trauma patients with blunt pelvic fractures who underwent REBOA placement and/or PP before laparotomy and/or angioembolization. Propensity score matching was performed adjusting for demographics, vitals, mechanism of injury, ISS, each body region-AIS, and pelvic fracture type. Outcomes were complication rates and mortality. RESULTS A total of 156 patients (PP: 52; REBOA: 52; REBOA+PP: 52) were matched and included. Mean age was 43±18 years, ISS was 28[17-32], and 74% were males. Overall mortality was 42%. The 24-hour mortality (25% vs 14% vs 35%; p=0.042), in-hospital mortality (44% vs 29% vs 54%; p=0.034), and 4-hour pRBC units transfused (15[9-23] vs 10[4-19] vs 16[9-27]; p=0.017) were lower in the REBOA group. The REBOA group had faster times to both laparotomy (p=0.040) and/or angioembolization (p=0.012). There was no difference between the groups in AKI, lower limb amputations, or hospital and ICU-LOS among survivors. CONCLUSION REBOA is a less invasive procedure compared to PP and is associated with improved outcomes. Further clinical trials are needed to define the optimal patient who will benefit from REBOA.