{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:35:29Z","timestamp":1790098529716,"version":"4.0.1"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:sec id=\"ab-soi220092-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Aortic occlusion (AO) is a lifesaving therapy for the treatment of severe traumatic hemorrhagic shock; however, there remains controversy whether AO should be accomplished via resuscitative thoracotomy (RT) or via endovascular balloon occlusion of the aorta (REBOA) in zone 1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220092-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare outcomes of AO via RT vs REBOA zone 1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220092-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This was a comparative effectiveness research study using a multicenter registry of postinjury AO from October 2013 to September 2021. AO via REBOA zone 1 (above celiac artery) was compared with RT performed in the emergency department of facilities experienced in both procedures and documented in the prospective multicenter Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry. Propensity score matching (PSM) with exact institution matching was used, in addition to subgroup multivariate analysis to control for confounders. The study setting included the ED, where AO via RT or REBOA was performed, and participants were adult trauma patients 16 years or older.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220092-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>AO via REBOA zone 1 vs RT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220092-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The primary outcome was survival. Secondary outcomes were ventilation-free days (VFDs), intensive care unit (ICU)\u2013free days, discharge Glasgow Coma Scale score, and Glasgow Outcome Score (GOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220092-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 991 patients (median [IQR] age, 32 [25-48] years; 808 male individuals [81.9%]) with a median (IQR) Injury Severity Score of 29 (18-50) were included. Of the total participants, 306 (30.9%) had AO via REBOA zone 1, and 685 (69.1%) had AO via RT. PSM selected 112 comparable patients (56 pairs). REBOA zone 1 was associated with a statistically significant lower mortality compared with RT (78.6% [44] vs 92.9% [52];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.03). There were no significant differences in VFD greater than 0 (REBOA,\u200918.5% [10] vs RT,\u20097.1% [4];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.07), ICU-free days greater than 0 (REBOA,\u200918.2% [10] vs RT,\u20097.1% [4];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.08), or discharge GOS of 5 or more (REBOA,\u20097.5% [4] vs RT,\u20093.6% [2];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.38). Multivariate analysis confirmed the survival benefit of REBOA zone 1 after adjustment for significant confounders (relative risk [RR], 1.25; 95% CI, 1.15-1.36). In all subgroup analyses (cardiopulmonary resuscitation on arrival, traumatic brain injury, chest injury, pelvic injury, blunt\/penetrating mechanism, systolic blood pressure \u226460 mm Hg on AO initiation), REBOA zone 1 offered an either similar or superior survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-soi220092-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Results of this comparative effectiveness research suggest that REBOA zone 1 provided better or similar survival than RT for patients requiring AO postinjury. These findings provide the ethically necessary equipoise between these therapeutic approaches to allow the planning of a randomized controlled trial to establish the safety and effectiveness of REBOA zone 1 for AO in trauma resuscitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamasurg.2022.6393","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T11:02:12Z","timestamp":1671620532000},"page":"140","source":"Crossref","is-referenced-by-count":61,"title":["Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock"],"prefix":"10.1001","volume":"158","author":[{"given":"Alexis L.","family":"Cralley","sequence":"first","affiliation":[{"name":"Department of Surgery, School of Medicine, University of Colorado, Denver"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navin","family":"Vigneshwar","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, University of Colorado, Denver"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest E.","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, University of Colorado, Denver"},{"name":"Ernest E. 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