{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:10:28Z","timestamp":1789737028511,"version":"4.0.1"},"reference-count":21,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"unspecified","delay-in-days":42,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2025,10,17]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma is debated. We hypothesized that the use of REBOA for patients presenting in shock after penetrating abdominal trauma is associated with delay to laparotomy and increased mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>We used 2017\u20132021 Trauma Quality Improvement Project data to identify adult (\u226516 years) penetrating abdominal trauma patients with systolic blood pressure (SBP) \u226490\u2009mm Hg undergoing laparotomy. REBOA was defined by International Classification of Diseases-10 code, with a procedure timestamp preceding or simultaneous to laparotomy incision. We propensity score matched REBOA to non-REBOA patients on demographics, mechanism, injury characteristics and severity, solid organ injury, abdominal vascular injury, SBP, heart rate, and Glasgow Coma Scale motor score. Outcomes were time to incision, transfusion requirements, complications, and in-hospital mortality. We additionally performed a survival analysis stratified by presenting SBP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 148 REBOA patients with complete data for matching to 280 non-REBOA patients. Among patients with REBOA timestamps preceding laparotomy incision, there was a delay to laparotomy (time to incision 40 (31\u201350) vs 31 (24\u201343) min, p=0.001). Overall, REBOA was associated with increased transfusion volume (median (IQR) packed red blood cells 5,125 (2,100\u20139,100) vs 2,925 (1,250\u20135,500) ccs in the first 4\u2009hours, p&lt;0.001), leg amputations (3.4% vs 0.4%, p=0.010), and mortality (53.4% vs 42.5%, p=0.032). The mortality relationship persisted on 30-day survival analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>REBOA for patients in shock after penetrating abdominal trauma is associated with delay to operation, greater transfusion requirement, leg amputation, and mortality. Our data support the need for expeditious definitive hemorrhage control in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>III, retrospective cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2024-001740","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T10:20:19Z","timestamp":1762942819000},"page":"e001740","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["REBOA in shocked penetrating abdominal trauma patients: impact on outcomes"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6497-3272","authenticated-orcid":false,"given":"Justin S","family":"Hatchimonji","sequence":"first","affiliation":[{"name":"Section of Trauma and Acute Care Surgery, University of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0723-0832","authenticated-orcid":false,"given":"Diane N","family":"Haddad","sequence":"additional","affiliation":[{"name":"Section of Trauma and Acute Care Surgery, University of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Maurer","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Brigham, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1224-2004","authenticated-orcid":false,"given":"Phillip M","family":"Dowzicky","sequence":"additional","affiliation":[{"name":"Section of Trauma and Acute Care Surgery, University of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Division of Acute Care Surgery, University of Michigan, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2157-0825","authenticated-orcid":false,"given":"Niels D","family":"Martin","sequence":"additional","affiliation":[{"name":"Division of Traumatology, Emergency Surgery, and Surgical Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick M","family":"Reilly","sequence":"additional","affiliation":[{"name":"Division of Traumatology, Emergency Surgery, and Surgical Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Yelon","sequence":"additional","affiliation":[{"name":"F Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J","family":"Seamon","sequence":"additional","affiliation":[{"name":"Division of Traumatology, Emergency Surgery, and Surgical Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"key":"2025111202201208000_10.4.e001740.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1705649"},{"key":"2025111202201208000_10.4.e001740.2","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1056\/NEJMra1609326","article-title":"Initial Care of the Severely Injured Patient","volume":"380","author":"King","year":"2019","journal-title":"N Engl J Med"},{"key":"2025111202201208000_10.4.e001740.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2013.05.099"},{"key":"2025111202201208000_10.4.e001740.4","first-page":"65","article-title":"Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man","volume":"36","author":"HUGHES","year":"1954","journal-title":"Surgery"},{"key":"2025111202201208000_10.4.e001740.5","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1093\/milmed\/usy143","article-title":"Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Hemorrhagic Shock","volume":"183","author":"Cannon","year":"2018","journal-title":"Mil Med"},{"key":"2025111202201208000_10.4.e001740.6","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000609"},{"key":"2025111202201208000_10.4.e001740.7","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1001\/jamasurg.2017.3549","article-title":"Use of Resuscitative Endovascular Balloon Occlusion of the Aorta for Proximal Aortic Control in Patients With Severe Hemorrhage and Arrest","volume":"153","author":"Brenner","year":"2018","journal-title":"JAMA 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Resuscitation After Severe Hemorrhagic Shock","volume":"158","author":"Cralley","year":"2023","journal-title":"JAMA Surg"},{"key":"2025111202201208000_10.4.e001740.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.01.013"},{"key":"2025111202201208000_10.4.e001740.13","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/70.1.41"},{"key":"2025111202201208000_10.4.e001740.14","doi-asserted-by":"publisher","DOI":"10.1023\/A:1020363010465"},{"key":"2025111202201208000_10.4.e001740.15","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/TA.0000000000004160","article-title":"Critical systolic blood pressure threshold for endovascular aortic occlusion-A multinational analysis to determine when to place a REBOA","volume":"96","author":"Ordo\u00f1ez","year":"2024","journal-title":"J Trauma Acute Care 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REBOA Cases","volume":"77","author":"Hatchimonji","year":"2020","journal-title":"J Surg Educ"},{"key":"2025111202201208000_10.4.e001740.20","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/j.jamcollsurg.2018.01.044","article-title":"Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma\u2019s Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry","volume":"226","author":"Brenner","year":"2018","journal-title":"J Am Coll Surg"},{"key":"2025111202201208000_10.4.e001740.21","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1093\/milmed\/usae089","article-title":"When Every Minute Counts: REBOA Before Surgery Is Independently Associated With a 15-Minute Delay in Time to Definitive Hemorrhage Control","volume":"189","author":"Colosimo","year":"2024","journal-title":"Mil 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