A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation

Brenner, Megan; Moore, Laura J.; DuBose, Joseph J.; Tyson, George H.; McNutt, Michelle K.; Albarado, Rondel; Holcomb, John B.; Scalea, Thomas M.; Rasmussen, Todd E.

doi:10.1097/ta.0b013e31829e5416

Cited by 384 publications

(235 citation statements)

References 23 publications

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“…Numerous clinical and preclinical studies support the utility of REBOA in restoring hemodynamics in the context of hemorrhagic shock (15)(16)(17)(18)(19)(20)(21)(22). Nonetheless, physiological tolerance to aortic occlusion is related to the metabolic and vascular impact in the areas proximal and distal to the balloon.…”

Section: Physiological Effects Of the Aortic Occlusion: Proximal And mentioning

confidence: 99%

“…Hypoxia activates the anaerobic metabolism of the cells, thus increasing lactate levels and contributing to the lethal triad of hypothermia, acidosis and coagulopathy (17,14,25). This tendency has, however, shown to be less severe in REBOA than in RT in a swine model (18). Histologic evidence of visceral lesion due to hypoperfusion has been inconsistently reported and its functional impact is actually unknown (17,22,25,26).…”

Section: Physiological Effects Of the Aortic Occlusion: Proximal And mentioning

confidence: 99%

“…Survival rates of trauma patients undergoing REBOA from available studies (USA, Japan and Europe) range from 13% to 67% (14)(15)(16)18,20,27,(29)(30)(31)(32)(33)(34). Unfortunately, there are huge discrepancies in methodology, inclusion criteria and interventions.…”

Section: Outcomes Features and Keys For Successmentioning

confidence: 99%

“…Morphometric studies have proven the association of external corporal measurements, and other parameters, with the depth of insertion needed to deploy the balloon at the target site (32,33) This supports the feasibility of an accurate deploy of the balloon by the only means of physical exam. Most studies do not to use any imaging (16,18,20,31,34) and as such does not require either a vascular surgeon or interventional radiologist.…”

Section: Outcomes Features and Keys For Successmentioning

confidence: 99%

See 3 more Smart Citations

Resuscitative endovascular balloon occlusion of the aorta (REBOA): What have we learned?

Andrés

Scott²,

Giannoudis

2016

Injury

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Section: Physiological Effects Of the Aortic Occlusion: Proximal And mentioning

confidence: 99%

Section: Physiological Effects Of the Aortic Occlusion: Proximal And mentioning

confidence: 99%

Section: Outcomes Features and Keys For Successmentioning

confidence: 99%

Section: Outcomes Features and Keys For Successmentioning

confidence: 99%

See 2 more Smart Citations

Resuscitative endovascular balloon occlusion of the aorta (REBOA): What have we learned?

Andrés

Scott²,

Giannoudis

2016

Injury

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“…It is increasingly recognized that trauma mortality is directly correlated with the time required to control non-compressible cavitary bleeding. This concept has been advanced further in patients sustaining severe abdominal trauma or pelvic fractures with the introduction of REBOA or peri-pelvic packing respectively to control lifethreatening hemorrhage [19,20]. The same urgency has not seemed to translate in patients sustaining thoracic trauma.…”

Section: Operative Managementmentioning

confidence: 99%

Operative Management of Lung Injuries

Livingston

2015

Curr Trauma Rep

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The need for operative management of pulmonary injury is uncommon. However, delaying patients requiring a thoracotomy for trauma increases morbidity and mortality; thus, the key aspect in management in this patient population is timely an operative intervention. Once the decision is made to perform a thoracotomy, the goal is to obtain control of hemorrhage as soon as possible. Lung lacerations from penetrating trauma usually have a tract though the pulmonary parenchyma and are usually amenable to lung-sparing techniques such as tractotomy or limited resections. Injuries from blunt trauma usually result in more significant tearing of the lung and are more likely to require larger resections. With modern approach to resuscitation, it is more important to quickly control hemorrhage than to worry about removing Btoo much lung.^Damage control techniques including temporary hilar clamping and chest packing are useful adjuncts to achieve survivorship in those patients with extensive chest trauma.

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Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage

Jansen,

Hudson,

Cochran

et al. 2023

JAMA

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ImportanceBleeding is the most common cause of preventable death after trauma.ObjectiveTo determine the effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) when used in the emergency department along with standard care vs standard care alone on mortality in trauma patients with exsanguinating hemorrhage.Design, Setting, and ParticipantsPragmatic, bayesian, randomized clinical trial conducted at 16 major trauma centers in the UK. Patients aged 16 years or older with exsanguinating hemorrhage were enrolled between October 2017 and March 2022 and followed up for 90 days.InterventionPatients were randomly assigned (1:1 allocation) to a strategy that included REBOA and standard care (n = 46) or standard care alone (n = 44).Main Outcomes and MeasuresThe primary outcome was all-cause mortality at 90 days. Ten secondary outcomes included mortality at 6 months, while in the hospital, and within 24 hours, 6 hours, or 3 hours; the need for definitive hemorrhage control procedures; time to commencement of definitive hemorrhage control procedures; complications; length of stay; blood product use; and cause of death.ResultsOf the 90 patients (median age, 41 years [IQR, 31-59 years]; 62 [69%] were male; and the median Injury Severity Score was 41 [IQR, 29-50]) randomized, 89 were included in the primary outcome analysis because 1 patient in the standard care alone group declined to provide consent for continued participation and data collection 4 days after enrollment. At 90 days, 25 of 46 patients (54%) had experienced all-cause mortality in the REBOA and standard care group vs 18 of 43 patients (42%) in the standard care alone group (odds ratio [OR], 1.58 [95% credible interval, 0.72-3.52]; posterior probability of an OR &gt;1 [indicating increased odds of death with REBOA], 86.9%). Among the 10 secondary outcomes, the ORs for mortality and the posterior probabilities of an OR greater than 1 for 6-month, in-hospital, and 24-, 6-, or 3-hour mortality were all increased in the REBOA and standard care group, and the ORs were increased with earlier mortality end points. There were more deaths due to bleeding in the REBOA and standard care group (8 of 25 patients [32%]) than in standard care alone group (3 of 18 patients [17%]), and most occurred within 24 hours.Conclusions and RelevanceIn trauma patients with exsanguinating hemorrhage, a strategy of REBOA and standard care in the emergency department does not reduce, and may increase, mortality compared with standard care alone.Trial Registrationisrctn.org Identifier: ISRCTN16184981

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A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation

Abstract: Therapeutic study, level V.

Cited by 384 publications

References 23 publications

Resuscitative endovascular balloon occlusion of the aorta (REBOA): What have we learned?

Resuscitative endovascular balloon occlusion of the aorta (REBOA): What have we learned?

Operative Management of Lung Injuries

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage

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