title: Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales.
abstract: BACKGROUND
  Non-compressible torso haemorrhage (NCTH) carries a high mortality in trauma as many patients exsanguinate prior to definitive haemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct that has the potential to bridge patients to definitive haemostasis. However, the proportion of trauma patients in whom REBOA may be utilised is unknown.
  
  
  METHODS
  We conducted a population based analysis of 2012-2013 Trauma Audit and Research Network (TARN) data. We identified the number of patients in whom REBOA may have been utilised, defined by an Abbreviated Injury Scale score ≥3 to abdominal solid organs, abdominal or pelvic vasculature, pelvic fracture with ring disruption or proximal traumatic lower limb amputation, together with a systolic blood pressure <90 mm Hg. Patients with non-compressible haemorrhage in the mediastinum, axilla, face or neck were excluded.
  
  
  RESULTS
  During 2012-2013, 72 677 adult trauma patients admitted to hospitals in England and Wales were identified. 397 patients had an indication(s) and no contraindications for REBOA with evidence of haemorrhagic shock: 69% men, median age 43 years and median Injury Severity Score 32. Overall mortality was 32%. Major trauma centres (MTCs) received the highest concentration of potential REBOA patients, and would be anticipated to receive a patient in whom REBOA may be utilised every 95 days, increasing to every 46 days in the 10 MTCs with the highest attendance of this injury type.
  
  
  CONCLUSIONS
  This TARN database analysis has identified a small group of severely injured, resource intensive patients with a highly lethal injury that is theoretically amenable to REBOA. The highest density of these patients is seen at MTCs, and as such a planned evaluation of REBOA should be further considered in these hospitals.
authors.affiliation: Institute of Naval Medicine, Gosport, Hampshire, UK Office of the Chief Scientist, 59th Medical Wing, Joint Base San Antonio, United States Air Force, San Antonio, Texas, USA.
authors.forename: Edward Benjamin Graham
authors.initials: EB
authors.lastname: Barnard
authors.affiliation: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Jonathan James
authors.initials: JJ
authors.lastname: Morrison
authors.affiliation: Medical School, University of Campinas, Campinas, Brazil.
authors.forename: Ricardo Mondoni
authors.initials: RM
authors.lastname: Madureira
authors.affiliation: Department of Anaesthetics, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Robbie
authors.initials: R
authors.lastname: Lendrum
authors.affiliation: Trauma Audit and Research Network, Hope Hospital, Manchester, UK.
authors.forename: Marisol
authors.initials: M
authors.lastname: Fragoso-Iñiguez
authors.affiliation: Trauma Audit and Research Network, Hope Hospital, Manchester, UK.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Trauma Audit and Research Network, Hope Hospital, Manchester, UK EMRiS Group, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lecky
authors.affiliation: Trauma Audit and Research Network, Hope Hospital, Manchester, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Bouamra
authors.affiliation: Trauma Audit and Research Network, Hope Hospital, Manchester, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lawrence
authors.affiliation: Departments of Surgery and Intensive Care Medicine, Aberdeen Royal Infirmary, Aberdeen, UK Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Jan Olaf
authors.initials: JO
authors.lastname: Jansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods*; D054869:Clinical Audit; D057510:Endovascular Procedures / Q000379:methods*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D014852:Wales / Q000453:epidemiology
keywords: Trauma; Trauma, abdomen; Trauma, epidemiology; Trauma, majot trauma management; resuscitation