Mil Med. 2026 May 22:usag223. doi: 10.1093/milmed/usag223. Online ahead of print.
ABSTRACT
INTRODUCTION: The use of Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for life-threatening trauma has increased and its association with improved survival outcomes compared to resuscitative thoracotomy (RT) has been reported in civilian literature, however data from military settings has been limited. Achieving rapid hemorrhage control is essential to preventing battlefield fatalities. During modern combat casualty care, REBOA offers a solution to non-compressible torso hemorrhage (NCTH) and may reduce complications associated with RT. The purpose of this study is to examine survival rates between Zone 1 REBOA and RT with aortic cross clamping in deployed environments over a 6-year study period.
MATERIALS AND METHODS: This study received IRB approval at Brooke Army Medical Center (BAMC), San Antonio, TX. A retrospective analysis was performed to compare outcomes in deployed military personnel following the use of RT and REBOA with NCTH using data from the Department of Defense Trauma Registry January 2017-May 2022. Comparative, descriptive, and summary statistical analyses were utilized to evaluate relative risk and hazards ratio of death after REBOA placement or thoracotomy (P < .05). Univariate propensity matching was used to control for differences in injury severity score between the 2 cohorts.
RESULTS: A total of 9 REBOA and 23 RT patients were identified, with 88.9% of REBOA patients and 44% of RT patients surviving to evacuation to the next role of care and to hospital discharge (P = .039). No difference in hospital length of stay, ICU stay, or ventilator days was seen between the cohorts. In surviving patients, complications following aortic occlusion with REBOA and RT are reported with no appreciable complication rates following extended aortic occlusion time beyond 30 minutes (max 60 minutes). The small sample and low number of events limit the robustness of these findings and call for cautious interpretation.
CONCLUSIONS: This retrospective analysis comparing Zone 1 REBOA and RT for NCTH in a U.S. military deployed setting demonstrates association of REBOA with improved survival compared to RT. However, these findings are limited by a small sample size and potential selection bias inherent to retrospective design and clinician-driven procedural choice, particularly in cases perceived as survivable. As such, the results should be interpreted with caution and considered hypothesis-generating, warranting further investigation in larger, more robust studies in order to define optimal REBOA use in an austere environment. Despite the limitations, these results highlight REBOA’s potential use in resource limited environments and can improve the ability to triage multiple casualties.
PMID:42172583 | DOI:10.1093/milmed/usag223
