Feasibility and Clinical Outcome Of REBOA in Patients With Impending Traumatic Cardiac Arrest

McGreevy, David; Abu‐Zidan, Fikri M.; Sadeghi, Mitra; Pirouzram, Artai; Toivola, Asko; Skoog, Per; Idoguchi, Koji; Kon, Yuri; Ishida, Toshiro; Matsumura, Yosuke; Matsumoto, Junya; Reva, Viktor; Maszkowski, Mariusz; Bersztel, Adam; Caragounis, Eva-Corina; Falkenberg, Mårten; Handolin, Lauri; Oosthuizen, George; Szarka, Endre; Manchev, V; Wannatoop, Tongporn; Chang, Shih-Heng; Kessel, Boris; Hebron, Dan; Shaked, Gadi; Bala, Miklosh; Coccolini, F.; Ansaloni, Luca; Dogan, Emanuel M.; Manning, James E.; Hibert-Carius, Peter; Larzon, Thomas; Nilsson, Kristofer F.; Hörer, Tal M.

doi:10.1016/j.ejvs.2019.09.443

Cited by 15 publications

(24 citation statements)

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“…With increased experience over time, subsequent studies have shown more successful percutaneous access [ 33 , 34 ]. Our study, similar to others, has shown that surgical cutdown is used less frequently and that use of external anatomic landmarks and palpation alone to puncture the CFA has a high rate of success [ 3 ]. This could be related to the availability of smaller and guidewire-free REBOA catheters such as the ER-REBOA™ catheter (Boerne, TX, USA), which is compatible with many 7 Fr sheaths.…”

Section: Discussionsupporting

confidence: 83%

Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

et al. 2020

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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about “Who is and who should be performing it?” Methods Data from the international ABO (aortic balloon occlusion) Trauma Registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how, and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients. Results During the study period, 259 patients had been recorded in the registry, 72.5% (n = 188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5%, and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common femoral artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cutdown in 57 patients (24%), using ultrasound in 49 patients (21%), and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient’s age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room, and mortality. Conclusion A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cutdown is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing “Who should be performing REBOA?” future research should focus on “Which patient benefits most from REBOA?”

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Section: Discussionsupporting

confidence: 83%

Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

et al. 2020

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“…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 Once in the desired position the balloon at the tip of the REBOA catheter is inflated with a radiopaque solution, fully occluding the aorta.…”

Section: Reboa Deployment During Cprmentioning

confidence: 99%

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

et al. 2020

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been proposed as a novel approach to managing non‐traumatic cardiac arrest (NTCA). During cardiac arrest, cardiac output ceases and perfusion of vital organs is compromised. Traditional advanced cardiac life support (ACLS) measures and cardiopulmonary resuscitation are often unable to achieve return of spontaneous circulation (ROSC). During insertion of REBOA a balloon‐tipped catheter is placed into the femoral artery and advanced in a retrograde manner into the aorta while the patient is undergoing cardiopulmonary resuscitation (CPR). The balloon is then inflated to fully occlude the aorta. The literature surrounding the use of aortic occlusion in non‐traumatic cardiac arrest is limited to animal studies, case reports and one recent non‐controlled feasibility trial. In both human and animal studies, preliminary data show that REBOA may improve coronary and cerebral perfusion pressures and key physiologic parameters during cardiac arrest resuscitation, and animal data have demonstrated improved rates of ROSC. Multiple questions remain before REBOA can be considered as an adjunct to ACLS. If demonstrated to be effective clinically, REBOA represents a potentially cost‐effective and generalizable intervention that may improve quality of life for patients with non‐traumatic cardiac arrest.

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“…However, this does not per se confirm "true" cardiac arrest but may represent a state of inadequate perfusion with impending cardiac arrest. A current study demonstrated that REBOA in patients with impending cardiac arrest is feasible and showed a survival rate of 37% [3]. The international resuscitation guidelines (ERC and AHA) advocate a consistent approach to CPR on the basis of upto-date evidence and expert's consensus opinions about the use of invasive measures, including resuscitative thoracotomy (RT), in order to eliminate reversible causes of cardiac arrest in trauma patients [2,[4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry

et al. 2020

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Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to the hospital with ongoing CPR. Nine patients (35%) died within the first 24 h, while seventeen patients (65%) survived post 24 h. The survival rate to hospital discharge was 27% (n = 7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p = 0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 nonresponders survived. The survival rate in the 16 patients responding to REBOA was 37.5% (n = 6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from the median (range) 56.5 (0-147) to 90 (0-200) mmHg. Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated.

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Feasibility and Clinical Outcome Of REBOA in Patients With Impending Traumatic Cardiac Arrest

Cited by 15 publications

References 0 publications

Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

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

Pre-hospital CPR and early REBOA in trauma patients — results from the ABOTrauma Registry

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