Feasibility and Proposed Training Pathway for Austere Application of Resuscitative Balloon Occlusion of the Aorta

Ross, Elliot; Redman, Theodore T.

doi:10.55460/qb5t-9jaq

Cited by 15 publications

(2 citation statements)

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“…Using REBOA in the resuscitation of a severely injured trauma patient is a team sport, and both surgeons and emergency physicians who may be deployed to the austere environment must be trained in the placement, use, and monitoring of REBOA in severely injured patients. 97,98 Even more far forward, efforts have been made to train nonphysicians, including military medical technicians and nurses who may have earlier access to combat casualties and have been successful. 99 Low-cost REBOA trainers have been developed, which could improve access to training resources in the austere setting.…”

Section: Provider Trainingmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

Stokes

Theodorou

Zakaluzny

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Noncompressible torso hemorrhage is a leading cause of preventable death on the battlefield. Intra-aortic balloon occlusion was first used in combat in the 1950s, but military use was rare before Operation Iraqi Freedom and Operation Enduring Freedom. During these wars, the combination of an increasing number of deployed vascular surgeons and a significant rise in deaths from hemorrhage resulted in novel adaptations of resuscitative endovascular balloon occlusion of the aorta (REBOA) technology, increasing its potential application in combat. We describe the background of REBOA development in response to a need for minimally invasive intervention for hemorrhage control and provide a detailed review of all published cases (n = 47) of REBOA use for combat casualties. The current limitations of REBOA are described, including distal ischemia and reperfusion injury, as well as ongoing research efforts to adapt REBOA for prolonged use in the austere setting.

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Section: Provider Trainingmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

Stokes

Theodorou

Zakaluzny

et al. 2021

J Trauma Acute Care Surg

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“…As a result, the reported rates of mortality and morbidity in patients receiving REBOA vary widely between studies. [29][30][31] Nevertheless, REBOA is gaining popularity and demonstrating utility for rapid control of catastrophic bleeding both in the hospital and in the field, 32,33 and substantial efforts are focused on making it safer and more effective through enabling automated vessel access, refining inflation techniques (i.e., partial or intermittent REBOA), 34 or characterizing catheter advancement distances. 20,28,35,36 In this study, we present a comprehensive analysis evaluating the effects of age, sex, aortic morphometry, flow pressures, balloon type, and inflation volume and pressure on the safety and effectiveness of REBOA occlusion.…”

Section: Discussionmentioning

confidence: 99%

Safe balloon inflation parameters for resuscitative endovascular balloon occlusion of the aorta

Maleckis¹,

Keiser²,

Jadidi³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND: Noncompressible hemorrhage is a leading cause of preventable death in civilian and military trauma populations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a promising method for controlling noncompressible hemorrhage, but safe balloon inflation parameters are not well defined. Our goal was to determine the balloon inflation parameters associated with benchtop flow occlusion and aortic/balloon rupture in ex vivo human aortas and test the hypothesis that optimal balloon inflation characteristics depend on systolic pressure and subject demographics. METHODS:Aortic occlusion parameters in human thoracic aortas (TAs) and abdominal aortas (AAs) from 79 tissue donors (median ± SD age, 52 ± 18 years [range, 13-75 years]; male, 52; female, 27) were recorded under 100/40, 150/40, and 200/40 mm Hg flow pressures for ER-REBOA and Coda balloons. Rupture tests were done with Coda balloons only without flow. RESULTS:In the TA, the average balloon inflation volumes and pressures resulting in 100/40 mm Hg flow occlusion were 11.7 ± 3.8 mL and 174 ± 65 mm Hg for the ER-REBOA, and 10.6 ± 4.3 mL and 94 ± 57 mm Hg for the Coda balloons. In the AA, these values were 6.2 ± 2.6 mL and 110 ± 47 mm Hg for the ER-REBOA, and 5.9 ± 2.2 mL and 71 ± 30 mm Hg for the Coda. The average balloon inflation parameters associated with aortic/Coda balloon rupture were 39.1 ± 6.5 mL and 1,284 ± 385 mm Hg in the TA, and 27.7 ± 7.7 mL and 1,410 ± 483 mm Hg in the AA. Age, sex, and systolic pressure all had significant effects on balloon occlusion and rupture parameters. CONCLUSION: Optimal balloon inflation parameters depend on anatomical, physiological, and demographic characteristics. Pressure-guided rather than volume-guided balloon inflation may reduce the risk of aortic rupture. These results can be used to help improve the safety of REBOA procedures and devices.

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Prehospital and Austere EVTM

Reva

2019

Endovascular Resuscitation and Trauma Management

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Feasibility and Proposed Training Pathway for Austere Application of Resuscitative Balloon Occlusion of the Aorta

Cited by 15 publications

References 0 publications

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

Safe balloon inflation parameters for resuscitative endovascular balloon occlusion of the aorta

Prehospital and Austere EVTM

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