PurposeResuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary stabilization of patients with non-compressible torso hemorrhage. This technique has been increasingly used worldwide during the past decade. Despite the good outcomes of translational studies, clinical studies are divided. The aim of this multicenter-international study was to capture REBOA-specific data and outcomes.MethodsREBOA practicing centers were invited to join this online register, which was established in September 2014. REBOA cases were reported, both retrospective and prospective. Demographics, injury patterns, hemodynamic variables, REBOA-specific data, complications and 30-days mortality were reported.ResultsNinety-six cases from 6 different countries were reported between 2011 and 2016. Mean age was 52 ± 22 years and 88% of the cases were blunt trauma with a median injury severity score (ISS) of 41 (IQR 29–50). In the majority of the cases, Zone I REBOA was used. Median systolic blood pressure before balloon inflation was 60 mmHg (IQR 40–80), which increased to 100 mmHg (IQR 80–128) after inflation. Continuous occlusion was applied in 52% of the patients, and 48% received non-continuous occlusion. Occlusion time longer than 60 min was reported as 38 and 14% in the non-continuous and continuous groups, respectively. Complications, such as extremity compartment syndrome (n = 3), were only noted in the continuous occlusion group. The 30-day mortality for non-continuous REBOA was 48%, and 64% for continuous occlusion.ConclusionsThis observational multicenter study presents results regarding continuous and non-continuous REBOA with favorable outcomes. However, further prospective studies are needed to be able to draw conclusions on morbidity and mortality.
Background:
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may improve Systolic Blood Pressure (SBP) in hypovolemic shock. It has, however, not been studied in patients with impending traumatic cardiac arrest (ITCA). We aimed to study the feasibility and clinical outcome of REBOA in patients with ITCA using data from the ABOTrauma Registry.
Methods:
Retrospective and prospective data on the use of REBOA from 16 centers globally were collected. SBP was measured both at pre- and post-REBOA inflation. Data collected included patients’ demography, vascular access technique, number of attempts, catheter size, operator, zone and duration of occlusion, and clinical outcome.
Results:
There were 74 patients in this high-risk patient group. REBOA was performed on all patients. A 7-10Fr catheter was used in 66.7% and 58.5% were placed on the first attempt, 52.1% through blind insertion and 93.2% inflated in Zone I, 64.8% for a period of 30 to 60 min, 82.1% by ER doctors, trauma surgeons, or vascular surgeons. SBP significantly improved to 90 mm Hg following the inflation of REBOA. 36.6% of the patients survived.
Conclusions:
Our study has shown that REBOA may be performed in patients with ITCA, SBP can be elevated, and 36.6% of the patients survived if REBOA placement is successful.
to the primary end point was analyzed. Results: Total of 300 bypasses were performed and 255 (85%) had DFUs. Mean follow up was 18.4 months. AFS was 91.4%, 62.9% and 57.4% in one month, 12 and 24 months respectively in diabetic patients and did not differ significantly from the non diabetics. There was a statistically significant increase in overall survival (p-0.045) in diabetics with a hazard ratio of 1.778 in non-diabetics after Cox regression analysis. Among the bypasses 119 (46%) were femoro-popliteal and 136 (54%) were pop-distal. AFS in pop distal bypasses was 67% and 62.2% in one and two years respectively while it was 58.3% in fem-pop bypasses in one year and 51.9% in two years. The values did not show any statistical significance and did not significantly differ from the non-diabetics. Median wound healing time was 3 months. Age, gender and smoking did not have a statistically significant effect on primary outcome. Conclusion: Lower limb arterial bypasses offer means of successful limb salvage and wound healing in diabetic patients with ischaemic foot ulcers. Further assessment, analysis and follow up are required on factors pertaining to wound care.
The interventional radiologist and the multidisciplinary team approach can be activated already on severe trauma patient arrival. ABO usage and other endovascular methods are becoming more widely spread, and can be used early in trauma management, without delay, thus justifying the early activation of this multidisciplinary approach.
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