(1743) Effective Usage of REBOA for Patients With Abdominal Trauma in the Hybrid Emergency Room System

Introduction: Hybrid Emergency Room System (HERS) is a trauma resuscitation room which equipped with a computed tomography scanner, fluoroscopy, and operating room set-up which allows simultaneous endovascular procedures and damage control surgery to be performed. After the installation of the HERS in July 2017 at our institution, we developed a trauma patient care protocol including indications for the resuscitative endovascular balloon occlusion of the aorta (REBOA) in April 2018. We conducted this study to investigate the utility of the REBOA in patients with hemorrhagic shock due to abdominal trauma who required laparotomy in the HERS.

Methods: A retrospective review of trauma patients presented with hemorrhagic shock and underwent trauma laparotomy at our institution from April 2013 to April 2024 was conducted. The frequency of the usage of the REBOA before the installation of HERS (pre-HERS era: April 2013 to June 2017) and after the installation of the HERS protocol (HERS era: April 2018 to April 2024) were reviewed. Outcomes were compared between two groups.

Results: The number of trauma surgeries was 105 in the pre-HERS era and 276 in the HERS era. Of these, 25 emergency trauma laparotomies were performed for patient with hemorrhagic shock in the pre-HERS era, and 38 in the HERS era. Compared to the pre-HERS era, the frequency of REBOA use increased (4% [1/25] vs. 26% [10/38], p=0.02), and the frequency of resuscitative thoracotomy was unchanged (28% [7/25] vs. 24% [9/38], p=0.70 in the HERS era. In addition, 70% [7/10] of cases of REBOA use in the HERS era were prophylactically implanted prior to laparotomy to prevent cardiac arrest due to massive hemorrhage. Mortality in patients who required aortic control (REBOA or resuscitative thoracotomy) tended to be lower in the HERS era than in the pre-HERS era (88% [7/8] vs 53% [10/19], p=0.11).

Conclusions: The incorporation of REBOA indications into trauma patient care protocols after the installation of the HERS increased the frequency of prophylactic REBOA placement to prevent cardiac arrest and resulted in a downward trend in mortality for those patients. In recent years, the usefulness of REBOA for trauma patients has been questioned, but it may be useful if used appropriately in selected patients.