Feasibility and Clinical Outcome of Reboa in Patients with Impending Traumatic Cardiac Arrest

Abstract

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.

Damage control resuscitation: REBOA as the new fourth pillar

“…• REBOA is not only a tool that aids in the control of hemorrhage, it is also a vital tool in the hemodynamic resuscitation of a severely injured patient allowing for the intravascular volumetric content to remain directed towards essential organs which include the brain and the heart 44,45 • REBOA is a dynamic tool that requires the placement and ongoing management by a skilled and well-trained surgeon [46][47][48] • REBOA poses a new paradigm shift in which soon after the initial ABCDE evaluation proposed by ATLS, an introducer sheath should be placed via the common femoral artery in the Trauma Bay / ER, which allows for immediate ongoing real time blood pressure monitoring of the hemodynamically unstable severely injured trauma patient and if indicated (SBP <70 mmHg) the placement of a REBOA with the aim of reducing cell injury and hemodynamic decompensation by early proximal control of the source of bleeding in both blunt and penetrating trauma 42,46,49,50 It is our belief that the classic description of DCR may be leaving out one other crucial arm that may interact positively with the other three. We propose a new paradigm "The Fourth Pillar": Permissive Hypotension, Hemostatic Resuscitation, Damage Control Surgery and REBOA ( Figure 6).…”

“…REBOA poses a new paradigm shift in which soon after the initial ABCDE evaluation proposed by ATLS, an introducer sheath should be placed via the common femoral artery in the Trauma Bay / ER, which allows for immediate ongoing real time blood pressure monitoring of the hemodynamically unstable severely injured trauma patient and if indicated (SBP <70 mmHg) the placement of a REBOA with the aim of reducing cell injury and hemodynamic decompensation by early proximal control of the source of bleeding in both blunt and penetrating trauma 42 , 46 , 49 , 50 …”

“…Esto permite realizar un monitoreo en tiempo real de la presión arterial sistólica de un paciente hemodinámicamente inestable y con trauma severo. La indicación de colocar el REBOA (presión arterial sistólica <70 mmHg) es con el objetivo de reducir la lesión celular y la descompensación hemodinámica, por medio, del control de la fuente del sangrado tanto en el trauma cerrado como el penetrante 42 , 46 , 49 , 50 .…”

REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

“…REBOA is an important resuscitative tool that ultimately prevents hemodynamic collapse while at the same time maintains coronary and cerebral perfusion in hemodynamically unstable trauma patients, and due to its less invasive nature, it has become an alternative to resuscitative thoracotomy [9][10][11][12][13][14][15][16] . Hörer et al proposed the concept of Endovascular Resuscitation and Trauma Management, a vision that integrates a multidisciplinary patient-centered approach that achieves prompt and effective hemorrhage control with significantly less surgical insult 6,17 .…”

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for non‐traumatic cardiac arrest: A review

“…By contrast, over‐the‐wire catheters, such as the Coda Balloon Catheter (Cook Medical, Bloomington, IN) or REBOA Balloon Kit (Reboa Medical, Norway), are inserted after the depth of a guidewire tip has been confirmed radiographically 23,24 . Blind placement technique using anatomic landmarks and estimated distance has been developed for the use of REBOA in trauma patients 25,26 . This blind technique is likely adequate for use during NTCA and is currently in use in a Phase 1 clinical trial at Yale University 27 …”