How many patients could benefit from REBOA in prehospital care? A retrospective study of patients rescued by the doctors of the Paris fire brigade

Thabouillot, Oscar; Bertho, Kilian; Rozenberg, Emmanuel; N, Roche; Boddaert, Guillaume; Jost, Daniel; Tourtier, J.-P.

doi:10.1136/jramc-2018-000915

Cited by 26 publications

(22 citation statements)

References 17 publications

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“…In this series and similar studies, placement decision was made by a physician provider who determined its need using various methods, including physical examination with clinical findings such as abdominal distention and mechanism of trauma, and even focused assessment with sonography for trauma examinations in the setting of hemodynamic instability. 17 However, the skills of the providers in the prehospital setting vary, with paramedictrained providers participating in the vast majority of austere civilian and military trauma; Special Operations Surgical Team-level skill is not always available in the setting in which REBOA might be required to sustain a patient until definitive surgical management.…”

Section: Discussionmentioning

confidence: 99%

Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study

Henry¹,

Matsushima²,

Henry³

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used as part of damage control resuscitation for patients with non-compressible truncal hemorrhage. We hypothesized that there might be a select group of patients that could have benefited from prehospital placement of the REBOA. STUDY DESIGN: This was a retrospective cohort study including patients who presented to a Level I trauma center with cardiac arrest between January 2014 and March 2018. The findings of a full autopsy were reviewed for the details of internal injuries. A patient was determined to be a REBOA candidate if the patient sustained abdominal organ injuries or pelvic fractures and no associated severe head injuries. The candidate group was compared with the non-candidate group based on prehospital vital signs and other patient characteristics. A multiple logistic regression analysis was performed to identify certain prehospital factors associated with candidacy for prehospital REBOA. RESULTS:A total of 198 patients met our inclusion criteria. Of those, 27 (13.6%) patients were deemed REBOA candidates. Median Injury Severity Score was 22 (interquartile range 17 to 29). Patients in the candidate group were more likely to have a Glasgow Coma Scale score 9 (48% vs 15%; p ¼ 0.012), oxygen saturation >90% (56% vs 35%; p ¼ 0.03), and systolic blood pressure <90 mmHg (48% vs 26%; p ¼ 0.04) in the field. Logistic regression showed that these 3 clinical parameters of prehospital vital signs were significantly associated with REBOA candidacy. CONCLUSIONS: Our data suggest that >10% of trauma patients who presented with cardiac arrest could have benefited from prehospital REBOA. Additional prospective studies are warranted to validate the use of field vital signs in selecting candidates. (J Am Coll Surg 2019;229:383e388.

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Section: Discussionmentioning

confidence: 99%

Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study

Henry¹,

Matsushima²,

Henry³

et al. 2019

Journal of the American College of Surgeons

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“…The commonly used transfemoral approach appears contraindicated considering our case and potential additional damage to the tissue and vessels. Thabouillot et al performed a retrospective register study of trauma patients with bleeding of abdominal, pelvic and junctional origin with uncontrolled hemorrhagic shock and attempted resuscitation on scene [24]. They conclude that REBOA should be available on-scene and used by trained emergency personal.…”

Section: Resultsmentioning

confidence: 99%

Technical limitations of REBOA in a patient with exsanguinating pelvic crush trauma: a case report

et al. 2019

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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective adjunct in hemodynamic unstable patients with uncontrolled and non-compressible torso hemorrhage promoting temporary stability during injury repair. The aim of our study was to analyze real life usability of REBOA based on a case report and to review the literature with respect to its possibilities and limitations. Case presentation We present the case of a 17-years old female patient who sustained a severe roll-over trauma and pelvic crush injury as a bicyclist by a truck. Upon arrival of the first responders, the patient was awake, alert, and following commands. Subsequent to lifting the truck, the patient became hypotensive and required cardiopulmonary resuscitation, application of a pelvic binder, and endotracheal intubation at the accident scene. She was then admitted by ambulance to our trauma center under ongoing resuscitative measures. After primary survey, it was decided to perform a REBOA with surgical approach to the left femoral artery. Initial insertion of the catheter was successful but could not be advanced beyond the inguinal region. Hence, the patient was transferred to the operating room (OR) but died despite maximum therapy. In the OR and later autopsy, we found a long-distance ruptured and dehiscent external iliac artery with massive bleeding into the pelvis in the context of a bilateral vertical shear fractured pelvic bone. Conclusion REBOA can be a useful adjunct but there is a major limitation with potential vascular injury after pelvic trauma. In these situations, cross-clamping the proximal aorta or pre-peritoneal pelvic packing as “traditional” approaches of hemorrhage control during resuscitation may be the most considerable methods for temporary stabilization in severely injured trauma patients. More clinical and cadaveric studies are needed to further understand indications and limitations of REBOA after severe pelvic trauma.

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“…Similar support came from a trauma centre in Florida and yet another from Baltimore . In the pre‐hospital world there has been success in London and data from France suggest 3% of trauma patients (over 1000 per annum) could be eligible for REBOA . The military also describe impressive and successful case reports .…”

Section: Competing Interestsmentioning

confidence: 91%

REBOA: Where are we now?

Ellis

2020

Emerg Medicine Australasia

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How many patients could benefit from REBOA in prehospital care? A retrospective study of patients rescued by the doctors of the Paris fire brigade

Cited by 26 publications

References 17 publications

Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study

Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study

Technical limitations of REBOA in a patient with exsanguinating pelvic crush trauma: a case report

REBOA: Where are we now?

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