Delta Systolic Blood Pressure (SBP) Can be a Stronger Predictor of Mortality Than Pre-Aortic Occlusion SBP in Non-Compressible Torso Hemorrhage: an Abotrauma and AORTA Analysis

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Duchesne, JuanRiverside University Health System, Riverside, California, USA; Tulane University School of Medicine, New Orleans, Louisiana, USA (author)

Delta Systolic Blood Pressure (SBP) Can be a Stronger Predictor of Mortality Than Pre-Aortic Occlusion SBP in Non-Compressible Torso Hemorrhage : an Abotrauma and AORTA Analysis

Article/chapterEnglish2021

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Biomedical Press,2021
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LIBRIS-ID:oai:DiVA.org:oru-83601
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-83601URI
https://doi.org/10.1097/SHK.0000000000001560DOI

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Language:English
Summary in:English

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BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct for the management in patients with severe non-compressible torso hemorrhage (NCTH). Although guidelines have been developed to help with the best indications for REBOA utilization, no studies have addressed the significance of change in systolic blood pressure (ΔSBP) after REBOA insufflation. We hypothesized that ΔSBP would predict mortality in patients with NCTH and have utility as a surrogate marker for hemorrhage status.STUDY DESIGN: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. ΔSBP was defined as the difference between pre- and post-REBOA insertion SBP. Based on post-insertion SBP, patient hemorrhage status was categorized as responder or non-responder. A non-responder was defined as a hypotensive patient with systolic blood pressure (SBP) < 90 mmHg after REBOA placement with full aortic occlusion. Significance was set at P < 0.05.RESULTS: A total of 524 patients with NCTH were included. Most (74%) were male, 77% blunt injured with a median (IQR) age of 40 (27 - 58) years and ISS 34 (25 - 45). Overall mortality was 51.0%. 20% of patients were classified as non-responders. Demographic and injury descriptors did not differ between groups. Mortality was significantly higher in non-responders vs responders (64% vs 46%, respectively; P = 0.001). Non-responders had lower median pre-insertion SBP (50mmHg vs 67mmHg; P < 0.001) and lower ΔSBP (20mmHg vs 48mmHg; P < 0.001).CONCLUSION: REBOA non-responders present and remain persistently hypotensive and are more likely to die than responders, indicating a potential direct correlation between ΔSBP as a surrogate marker of hemorrhage volume status and mortality. Future prospective studies will need to further elucidate the impact of Damage Control Resuscitation efforts on ΔSBP and mortality.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Anestesi och intensivvård hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Anesthesiology and Intensive Care hsv//eng
Damage control resuscitation
massive transfusion protocol
non-compressible torso hemorrhage
resuscitative endovascular balloon occlusion of the aorta (REBOA)

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McGreevy, David,1988-Örebro universitet,Institutionen för medicinska vetenskaper,Department of Cardiothoracic & Vascular Surgery(Swepub:oru)dmy (author)
Nilsson, Kristofer F.,1981-Örebro universitet,Institutionen för medicinska vetenskaper,Department of Cardiothoracic & Vascular Surgery(Swepub:oru)krnn (author)
DuBose, JosephR. Adams Cowley Shock Trauma, Baltimore, Maryland, USA (author)
Rasmussen, Todd E.Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (author)
Brenner, MeganRiverside University Health System, Riverside, California, USA (author)
Jacome, TomasOur Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA (author)
Hörer, Tal M.,1971-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Cardiothoracic & Vascular Surgery(Swepub:oru)thr (author)
Tatum, DanielleOur Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA (author)
Riverside University Health System, Riverside, California, USA; Tulane University School of Medicine, New Orleans, Louisiana, USAInstitutionen för medicinska vetenskaper (creator_code:org_t)

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In:Shock: Biomedical Press56:1S, s. 30-361073-23221540-0514

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