LAUSR

To the Editor: W e read the article “The critical threshold value of systolic blood pressure for aortic occlusion in trauma patients in profound hemorrhagic shock” by Ordonez et al. with interest. The authors hypothesized that a critical systolic blood pressure (SBP) threshold upon admission exist in severely injured trauma patients that may trigger the use of an aortic occlusion (AO) and in turn be associated with a decrease likelihood of cardiac arrest and/or 24-hour mortality. In the current study, they concluded that the critical SBP threshold value to apply immediate AO was 60 mm Hg, and SBP value below 70mmHgwas associatedwith higher probability of cardiac arrest. Aortic occlusion is a method to temporize distal hemorrhage while augmenting cerebral and coronary perfusion. This can be performed through the abdomen, thorax, or, more recently, using intra-aortic balloon occlusion through a transfemoral approach. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) represents a new tool that can be used as an alternative to performing resuscitative thoracotomy (RT) in traumatic arrest and as an adjunct for intra-abdominal, pelvic, or junctional hemorrhage. In a recent report by the American Association for the Surgery of Trauma’s Aortic Occlusion in Resuscitation for Trauma andAcute Care Surgery (AAST AORTA) study group, REBOA was associated with higher systolic blood pressure and lower mortality rate compared to RTamong 285 severely injured trauma patients (202 RT, 83 REBOA) (2). It was also reported that an increase in SBP after AO in the REBOA group was 89 ± 65 mmHg and 30 ± 51 mmHg in the RT group, respectively (p < 0.001). Besides, the mortality rate was lower in the REBOA group (90.4%, 97.5% in the REBOA, and the RT group, respectively) (p = 0.023)