Resuscitative Endovascular Balloon Occlusion of the Aorta in Hemodynamically Unstable Patients with Pelvic Ring Injuries.

Objective To evaluate the outcomes of patients with pelvic ring injuries managed with resuscitative endovascular balloon occlusion of the aorta (REBOA). Design Retrospective case series. Setting Academic, level-1 trauma center in North America. Patients Twenty-five patients with disruption of the pelvic ring and hemodynamic instability. Intervention Placement of a REBOA as an adjuvant treatment to trauma resuscitation. Main outcome measure Death and ischemic related complications. Results Average age of patients was 43 years (range: 17-85). Patients presented with a median lactate of 6.3 mmol/L, systolic blood pressure of 116mmHg, heart rate of 121, and injury severity score of 34. The median units of pack red blood cells received via transfusion in the first 24 hours was 13 (IQR: 8-28). Young-Burgess injury patterns included: 5 LC-1, 1 LC-2, 8 LC-3, 4 APC-2, and 7 APC-3 fractures. Angiography and embolization was performed in 24 (96%) patients. Selective embolization occurred in 18 (72%) patients with non-selective angiography of the iliac system occurring in 7 (24%) patients. There were 12 (48%) deaths, 7 (28%) patients requiring lower extremity fasciotomy, 5 (20%) lower extremity amputations, and 1 (4%) thrombectomy. Conclusion REBOA use in pelvic ring injuries is rare and most frequently utilized in critically ill poly-trauma patients. Successful pelvic embolization can occur in concert with REBOA use, however the severity of injury is associated with a high complication profile. In this series of 25 patients in-hospital mortality was 48%. For those patients that survived 54% experienced a major complication (fasciotomy, amputation, deep infection). Further investigation is required to evaluate the role REBOA may play in managing these patients. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.