Recommendations for Initial Management of BAAI

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	RECOMMENDATIONS
1	C-LD	1. In patients with grade 1 to 2 BAAI (Table 33) without malperfusion, anti-impulse therapy, if clinically tolerated, and repeat imaging within 24 to 48 hours of the initial scan is recommended to reduce risk of injury progression.1
1	C-LD	2. In patients with grade 4 BAAI (Table 33), repair should be performed to address life-threatening aortic injury.2–4
2a	C-LD	3. In patients with grade 2 BAAI (Table 33) and associated malperfusion, it is reasonable to consider repair.1
2a	C-LD	4. In patients with BAAI, treatment with either endovascular or open repair is reasonable and depends on degree of injury, aortic anatomy, and the patient’s overall clinical status.1–4
2b	C-LD	5. In patients with grade 3 BAAI (Table 33), it may be reasonable to consider repair to reduce risk of progression to life-threatening injury.5
3: Harm	B-NR	6. In patients with BAAI, the usefulness of routine application of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhage control is unclear and, in some cases, may cause harm.6–8