In Reply We thank JAMA Surgery for the opportunity to reply to the comments raised in the letters to the editor regarding our article.¹ The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) has gained popularity since it has become more readily available.² However, there is limited high-grade evidence to guide its use and a considerable complication risk should this approach be used without appropriate indications. As with any developing technology, evidence-based research should be used to determine its indications, benefit, and hazards. Currently, available data are based on numerous small single-center studies of case reports or case series. Our study highlights the results of a nationwide sample that explored the outcomes of REBOA in patients with severe trauma injuries. In our propensity score–matched cohort, after adjusting for the spectrum of measurable confounding variables available in the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP), we found that REBOA is associated with a significant increase in mortality and complications. The ACS-TQIP is the largest high-quality nationally representative trauma registry that undergoes rigorous statistical adjustments.³ Ultimately, the data speak for themselves and are consistent with the findings from the Japan Trauma Data Bank. The relative infrequency of REBOA use prohibits retrospective analyses between centers to account for major differences in volume. However, it is still worthwhile to report the currently available data and to contemplate their merits.

在答复中，我们感谢JAMA Surgery能够答复写给编辑的信中有关我们文章的评论。¹复苏性主动脉腔内血管球囊阻塞（REBOA）的使用已变得普及，因为它变得更容易获得。^2个但是，指导使用它的高级证据有限，如果在没有适当适应症的情况下使用此方法，则存在相当大的并发症风险。与任何开发中的技术一样，应使用基于证据的研究来确定其适应症，益处和危害。当前，可用数据基于案例报告或案例系列的众多小型单中心研究。我们的研究重点介绍了一个全国性样本的结果，该样本探讨了严重外伤患者中REBOA的结果。在我们的倾向得分匹配队列中，在调整了美国外科医生学院创伤质量改进计划（ACS-TQIP）中可测量的混杂变量的范围之后，我们发现REBOA与死亡率和并发症的显着增加有关。³最终，这些数据可以说明一切，并且与日本创伤数据库的调查结果一致。REBOA使用频率相对较低，因此禁止在各中心之间进行回顾性分析，以解决数量上的重大差异。但是，仍然值得报告当前可用的数据并考虑它们的优点。