The Dirty Trust About REBOA: A Descriptive Analysis of Infection Rates in a High-Risk Population

Author(s):
James Walker; Courtney Meyer; Eunice Aworanti ; Christine Castater; S Rob Todd; Randi N. Smith; Jason Sciarretta; Jonathan Nguyen

Background:

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a viable alternative to open aortic occlusion for hemorrhage control. It is often performed without maximal barrier precautions, and thus sterility is not consistently ensured. As REBOA use increases, a knowledge gap exists in the infectious risks it poses to patients.

Hypothesis:

We sought to characterize the infectious complications and rates in patients who undergo REBOA.

Methods:

This was a retrospective analysis of all REBOA patients at our busy urban Level I Trauma Center since 2016. After obtaining institutional IRB approval, the trauma registry was queried for all patients who recieved REBOA. Basic demographics were obtained and infectious rates were identified. The medical record for bacteremic patients was then examined for the source of bacteremia. Patients who did not survive beyond hospital day 2 were excluded from analysis.

Results:

70 patients met inclusion criteria for 11/2016 through 09/2023. Patient demographics and infection rates are listed in Table 1. 26 patients had pneumonia (37%), while 12 patients had a deep or organ space surgical site infection (17%). 9 patients were found to have a bloodstream infection: 8 were bacteremic and 1 was fungemic. Table 2 lists bloodstream infections. No patients were bacteremic within 48 hours of REBOA placement. All bloodstream infections were associated with a non-REBOA source. No surgical site infections were identified at the site of vascular access.

Conclusions:

In this descriptive analysis of a single institution experience on trauma patients who underwent REBOA, we found a modest rate of infectious complications, comparable to published historical data. No bloodstream infections were linked to REBOA. While a small sample size, single institution experience, it serves as one of the first studies to describe the infection rates in patients undergoing REBOA. Further prospective multicenter studies are required to evaluate the true infectious risks associated with REBOA.