Resuscitative endovascular balloon occlusion of the aorta (REBOA) as a potential facilitator of definitive fascial closure in the open abdomen: a retrospective study in massive traumatic hemorrhage

Purpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) effectively reduces uncontrollable torso hemorrhage in trauma. An open abdomen (OA) with temporary abdominal closure commonly follows damage control surgery in such cases. Early definitive fascial closure (DFC) is crucial to prevent complications such as enteric fistula, peritoneal abscess, or chronic ventral hernia. This study aimed to evaluate the effect of REBOA on DFC after massive traumatic hemorrhage. Methods: This retrospective study analyzed 839 patients requiring massive transfusion at a level I trauma center between 2015 and 2022. Subgroup analyses were conducted among patients who underwent OA and DFC. Primary outcomes were DFC achievement and timing (≤48 hours vs. >48 hours). Secondary outcomes included various clinical outcomes. Results: Of 229 patients meeting inclusion criteria, 76 (33.2%) required OA management, of whom 33 (43.4%) achieved DFC. The OA+ group demonstrated more severe injury (median Injury Severity Score, 34.0 vs. 22.0; P<0.001) and higher REBOA utilization (47.4% vs. 15.0%, P<0.001). Multivariate analysis showed that bowel perforation (adjusted odds ratio [OR], 6.75; 95% confidence interval [CI], 1.56-29.23; P=0.011) and Sequential Organ Failure Assessment (SOFA) score (adjusted OR, 0.58; 95% CI, 0.43-0.79; P<0.001) were independently associated with DFC achievement; REBOA use was not. Among patients achieving DFC, univariate analysis identified OA indication (OR, 0.11), number of laparotomies (OR, 0.16), and crystalloid volume (OR, 1.00) as factors associated with early closure (≤48 hours), though none remained significant in multivariate analysis. Conclusions: Zone I REBOA did not significantly influence the achievement or timing of DFC following OA in trauma patients with massive hemorrhage. The deteriorating condition in REBOA recipients and the limited sample size may have affected these findings. Nevertheless, several clinical indicators were associated with DFC, suggesting potential utility in trauma care decisions.