Resuscitative endovascular balloon occlusion of the aorta in abdominal trauma: zone-specific outcomes and predictors of mortality

BACKGROUND: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasingly utilized for hemorrhage control in trauma; however, zone-specific outcomes in abdominal trauma remain inadequately characterized. METHODS: We retrospectively analyzed 404 patients with abdominal trauma who underwent REBOA between 2019 and 2022. Patients were stratified by aortic occlusion zone (zones 1, 2, or 3), and their demographic characteristics, injury patterns, resuscitation requirements, and clinical outcomes were compared. RESULTS: The cohort was predominantly male (83.8%), with a median age of 35.0 years. The distribution of the zones was as follows: Zone 1 (33.7%); Zone 2 (4.7%); and Zone 3 (61.6%). Patients in Zone 1 presented with more severe hemodynamic compromise (median SBP 77.0 mmHg vs. 107.0 mmHg in Zone 2 and 103.0 mmHg in Zone 3, P < 0.001) and lower GCS scores (median 6.0 vs. 15.0 in both Zones 2 and 3, P < 0.001). Mortality was significantly higher in Zone 1 (73.6%) than in Zones 2 (27.8%) and 3 (37.7%) (P < 0.001). Multivariate analysis identified GCS score (OR 0.80 per point increase, 95% CI 0.73–0.87, P < 0.001) and Zone 3 placement (OR 0.20 vs. Zone 1, 95% CI 0.08–0.47, P < 0.001) as independent predictors of survival. Overall mortality decreased from 58% in 2019 to 36% in 2022, despite the increased utilization of REBOA. CONCLUSION: REBOA zone placement and neurological status are powerful independent predictors of mortality in patients with abdominal trauma. These findings support a zone-specific approach to REBOA deployment in patients with abdominal trauma.