title: The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA).
abstract: Aortic occlusion (AO) for resuscitation in traumatic shock remains controversial. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers an emerging alternative.
  
  
  
  The American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry prospectively identified trauma patients requiring AO from eight ACS Level 1 centers. Presentation, intervention, and outcome variables were collected and analyzed to compare REBOA and open AO.
  
  
  
  From November 2013 to February 2015, 114 AO patients were captured (REBOA, 46; open AO, 68); 80.7% were male, and 62.3% were blunt injured. Aortic occlusion occurred in the emergency department (73.7%) or the operating room (26.3%). Hemodynamic improvement after AO was observed in 62.3% [REBOA, 67.4%; open OA, 61.8%); 36.0% achieving stability (systolic blood pressure consistently >90 mm Hg, >5 minutes); REBOA, 22 of 46 (47.8%); open OA, 19 of 68 (27.9%); p =0.014]. Resuscitative endovascular balloon occlusion of the aorta (REBOA) access was femoral cut-down (50%); US guided (10.9%) and percutaneous without imaging (28.3%). Deployment was achieved in Zones I (78.6%), II (2.4%), and III (19.0%). A second AO attempt was required in 9.6% [REBOA, 2 of 46 (4.3%); open OA, 9 of 68 (13.2%)]. Complications of REBOA were uncommon (pseudoaneurysm, 2.1%; embolism, 4.3%; limb ischemia, 0%). There was no difference in time to successful AO between REBOA and open procedures (REBOA, 6.6 ± 5.6 minutes; open OA, 7.2 ± 15.1; p = 0.842). Overall survival was 21.1% (24 of 114), with no significant difference between REBOA and open AO with regard to mortality [REBOA, 28.2% (13 of 46); open OA, 16.1% (11 of 68); p = 0.120].
  
  
  
  Resuscitative endovascular balloon occlusion of the aorta has emerged as a viable alternative to open AO in centers that have developed this capability. Further maturation of the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery database is required to better elucidate optimal indications and outcomes.
  
  
  
  Therapeutic/care management study, level IV.
authors.affiliation: From the David Grant Medical Center (J.J.D.), University of California-Davis, Davis, California; Department of Surgery (T.M.S., M.B.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland; Los Angeles County + University of Southern California Hospital (D.S., K.I.), Los Angeles, California; San Antonio Military Medical Center (J.C.), United States Army Institute of Surgical Research, San Antonio, Texas; University of Texas Health Sciences Center-Houston (L.M., J.H.), Houston, Texas; Loma Linda University Medical Center (D.T., C.N.A.), Loma Linda, California; University of Calgary (A.K., J.X.), Calgary, Alberta, Canada; University of Florida-Jacksonville (D.S.), Jacksonville, Florida; and East Carolina Medical Center (N.P.), New Bern, North Carolina.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DuBose
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: Megan
authors.initials: M
authors.lastname: Brenner
authors.forename: Dimitra
authors.initials: D
authors.lastname: Skiada
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cannon
authors.forename: Laura
authors.initials: L
authors.lastname: Moore
authors.forename: John
authors.initials: J
authors.lastname: Holcomb
authors.forename: David
authors.initials: D
authors.lastname: Turay
authors.forename: Cassra N
authors.initials: CN
authors.lastname: Arbabi
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirkpatrick
authors.forename: James
authors.initials: J
authors.lastname: Xiao
authors.forename: David
authors.initials: D
authors.lastname: Skarupa
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Poulin
mesh_terms: D000328:Adult; D001012:Aorta, Abdominal; D001013:Aorta, Thoracic; D021721:Balloon Occlusion; D057510:Endovascular Procedures; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012151:Resuscitation / Q000379:methods*; D014481:United States; D014947:Wounds and Injuries / Q000150:complications*