Zone 3 REBOA Use in Hypotensive Patients With Blunt Pelvic Trauma Requiring Hemorrhage Control Surgery: A National Retrospective Cohort Study

Abstract

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used for hemorrhage control in trauma patients, yet its role in blunt pelvic trauma remains controversial. This study evaluates outcomes in hypotensive patients with blunt pelvic trauma undergoing hemorrhage control surgery, comparing those who received zone 3 REBOA to those who did not.

Methods

A retrospective cohort analysis was conducted using the ACS Trauma Quality Programs Participant Use File (TQP-PUF) from 2016 to 2019. Adult patients (≥18 years) with hypotension (SBP <100 mmHg) and blunt pelvic trauma who underwent surgical hemorrhage control were included. Exclusion criteria included traumatic brain injury, preperitoneal packing, resuscitative thoracotomy/sternotomy, and bleeding diatheses. Propensity score matching (1:1) was used to compare patients who received zone 3 REBOA versus those who did not. Primary outcomes were 24-hour and in-hospital mortality. Secondary outcomes included transfusion volume, acute kidney injury (AKI), and lower extremity amputation.

Results

Of 4453 patients, 139 underwent REBOA. After matching, 121 patients remained per group. REBOA patients had significantly higher in-hospital mortality (50.5% vs 25.0%, P < 0.001) and 24-hour mortality (31.0% vs 14.3%, P = 0.002). The median PRBC transfusion was greater at 4 hours (4000 mL vs 1750 mL) and 24 hours (5600 mL vs 2800 mL) in the REBOA group (both P < 0.001). Acute kidney injury occurred more frequently in REBOA patients (15.7% vs 6.6%, P = 0.025).

Conclusions

Zone 3 REBOA in hypotensive blunt pelvic trauma was associated with higher mortality and transfusion needs. These findings highlight the need for cautious use and further prospective investigation.