An assessment of nationwide trends in emergency department (ED) resuscitative endovascular balloon occlusion of the aorta (REBOA) use – A trauma quality improvement program registry analysis

Background: Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for temporary hemorrhage control in severe non-compressible torso trauma remains controversial, with limited data on patient selection and outcomes. This study aims to analyze the nationwide trends of its use in the emergency department (EDs). Methods: A retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) from 2017 to 2022 was performed, focusing on REBOA placements in EDs. Results: The analysis included 3398 REBOA procedures. Majority patients were male (76 ​%) with a median age of 40 years (27–58) and injury severity score of 20 (20–41). The most common mechanism was collision (64 ​%), with emergency surgeries most frequently performed for pelvic trauma (14 ​%). Level 1 trauma centers performed 82 ​% of these procedures, with consistent low annual utilization (<200 facilities). Survival rates were 85 ​% at 1-h post-placement, decreasing significantly to 42 ​% by discharge. Conclusions: REBOA usage in remains limited but steady, primarily occurring at level 1 trauma center EDs. While short-term survival rates are favorable, they drop significantly by the time of discharge.