Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock

Research article

Takayuki Irahara, Norio Sato, Yuuta Moroe, Reo Fukuda, Yusuke Iwai and Kyoko Unemoto

World Journal of Emergency Surgery 2015, 10:1 
doi:10.1186/1749-7922-10-1

Published: 6 January 2015

Abstract (provisional)

Introduction

Intra-aortic balloon occlusion (IABO) is useful for proximal vascular control, by
clamping the descending aorta, in traumatic haemorrhagic shock. However, there are
limited clinical studies regarding its effectiveness. This study aimed at investigating
the effectiveness of IABO for traumatic haemorrhagic shock.

Methods

This retrospective, observational study included trauma patients who underwent IABO
at the Emergency and Critical Care Center of Nippon Medical School Tama-Nagayama Hospital
between January 2009 and March 2013. 14 patients were included to this study who were
in shock on arrival (systolic blood pressure [SBP] 90 mmHg or shock index =1), underwent
IABO for resuscitation and temporary haemostasis, and subsequently underwent haemostatic
intervention (operation or transcatheter arterial embolization). Patient characteristics,
physiological status, SBP, heart rate (HR), initial fluid and blood transfusion, time
course, and total occlusion time were compared before and after IABO as well as between
the survived (n = 5) and non-survived (n = 9) groups.

Results

The majority of patients experienced blunt injuries, with an average injury severity
score of 29.5. The liver, pelvis, spleen, and mesenterium represented the majority
of injured organs. SBP, but not HR, was significantly higher after IABO than before
IABO (123.1 vs. 65.5 mmHg, P = 0.0001). The revised trauma score and probability of
survival were significantly different between the survived and non-survived groups
(both, P = 0.04). The survived group required significantly less blood transfusion
volume than the non-survived group (20 vs. 33.7 red blood cell units, P = 0.04). In
addition, the survived group required a significantly shorter total occlusion time
than the non-survived group (46.2 vs. 224.1 min, P = 0.002).

Conclusions

IABO was used for relatively severe trauma patients. SBP was significantly higher
after IABO, but was not related to survival. However, blood transfusion volume and
total occlusion time were related to survival; therefore, it is important to reduce
or shorten these parameters, i.e., immediate definitive haemostasis. IABO is effective
for traumatic haemorrhagic shock; however, it is also important to consider these
points and potential complications.