Population  of  Interest

• Patients with injury to chest, abdomen, pelvis, and/or limb with SBP > 0 and < 90 or CPR in progress on arrival to first MTF AND not isolated head injury.
• Patients who received REBOA.

Intent  (Expected  Outcomes)

1. REBOA is not performed in patients with no signs of life or CPR > 15 minutes or isolated severe TBI, penetrating neck injury, or penetrating extremity injury.
2. If performed, REBOA was performed for the indication of hemorrhagic shock associated with abdominal, pelvic, or junctional lower extremity bleeding, or other indication is clearly documented.
3. If REBOA performed, the patient was assessed for thoracic hemorrhage (EFAST or chest X-ray (CXR) results documented, or bilateral chest tubes placed).
4. Blood pressure pre and post REBOA and balloon times (inflation and deflation) are documented in REBOA procedure note.
5. Lower extremity pulses are documented hourly for 24 hours after balloon deflation.

Performance/Adherence  Metrics

1. Patient did not have REBOA performed if patient had no signs of life or CPR > 15 minutes, isolated severe TBI, penetrating neck injury, or penetrating extremity injury.
2. Patient had REBOA performed for hemorrhagic shock associated with abdominal, pelvic, or junctional lower extremity bleeding, or another indication that was clearly documented.
3. Patient assessed for thoracic hemorrhage (EFAST or CXR results documented or bilateral chest tubes placed) prior to REBOA being performed.
4. Patient had REBOA performed with complete REBOA procedure note to include documented blood pressure pre and post REBOA and documented balloon times (inflation and deflation).
5. Patient had REBOA performed with lower extremity pulses documented hourly for 24 hours after balloon deflation.

Data  Source

• Patient Record
• Department of Defense Trauma Registry (DoDTR)

PI  Data  Capture  and  Reporting

• Number of REBOA interventions, performance, and adherence measures will be reported quarterly by JTS PI Branch Chief to the JTS Chief.
• JTS will identify REBOA patients in the trauma registry and facilitate capture of complete medical records.

System  Reporting  and  Frequency

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed.

The system review and data analysis will be performed by the JTS Chief, and the JTS PI Branch.

Responsibilities

It is the responsibility of the JTS PI Branch Chief to ensure system-level compliance with this CPG. It is the trauma team leader’s responsibility to ensure familiarity, appropriate compliance and PI monitoring at the local level with this CPG.