Optimizing resuscitative endovascular balloon occlusion of the aorta outcomes using phenotype analysis: A nationwide study

BACKGROUND: We aimed to identify clinical features of patients who most benefitted from resuscitative endovascular balloon occlusion of the aorta (REBOA). METHODS: Adult patients treated with REBOA were identified in the Japan Trauma Data Bank (2019–2022), and phenotype analyses were conducted. An estimated survival rate was calculated for each patient treated with REBOA adjusting for background and institution characteristics, which was compared with a general probability of survival calculated with Trauma and Injury Severity Score probability of survival. Patients were divided into four groups: notably higher, higher, notably lower, and lower survival than expected (>15% higher, 0–15% higher, ≥15% lower, and 0–15% lower than Trauma and Injury Severity Score probability of survival, respectively) groups. Then, clinical features were identified in patients with notably higher survival as significantly inclining/ declining variables across the groups. In the validation using 2010 to 2018 database, patients with these clinical features were selected, and in-hospital survival was compared between those with and without REBOA. RESULTS: Among 805 patients treated with REBOA, 180 (22.4%) had notably higher, and 240 (29.8%) had higher survival than expected. Glasgow Coma Scale score of ≤6, systolic blood pressure of ≤70 mm Hg, Abbreviated Injury Scale (AIS) in abdomen score of ≥3, and AIS in extremity/pelvis score of ≥4 were identified as the clinical features of patients with notably higher survival than expected. In the validation, 236 patients met all the identified features, and those with REBOA showed higher survival to discharge than those without (8/39 [21.6%] vs. 13/197 [7.3%]; odds ratio, 3.52 [1.34–9.25]) and more frequently underwent laparotomy and angiography for pelvis (odds ratio, 2.52 [1.24–5.11] and 2.31 [1.08–4.95], respectively). CONCLUSION: Patients with Glasgow Coma Scale score of ≤6, systolic blood pressure of ≤70 mm Hg, AIS in abdomen score of ≥3, and AIS in extremity/pelvis score of ≥4 were most likely to benefit from REBOA and had a higher survival rate by >30% than general trauma population treated without REBOA.