Intraoperative combination of resuscitative endovascular balloon occlusion of the aorta and a median sternotomy in hemodynamically unstable patients with penetrating chest trauma: Is this feasible?

Abstract

Therapeutic, level V.

Resuscitative endovascular balloon occlusion of the aorta (REBOA): indications: advantages and challenges of implementation in traumatic non-compressible torso hemorrhage

“…However, one recently published case series of seven patients by Ordonez et al challenged these recommendations, as they successfully used REBOA in conjunction with a median sternotomy in patients with penetrating thoracic trauma and significant intrathoracic injuries. The use of REBOA in those patients significantly increased the systolic blood pressure through intravascular blood redistribution and likely better cardiac and cerebral perfusion, till definitive control was established, without worsening bleeding or reported adverse effects; thus, its role in chest trauma is yet to be studied 80…”

“…Further studies are needed to define the role of REBOA in penetrating mechanism, especially with high-velocity missiles injuries 18 19 80…”

Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA, 2019: a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians

“…Use of REBOA in the setting of thoracic great vessel injury is limited to case reports where open thoracotomy and/or sternotomy is performed in conjunction with REBOA. In these situations, open thoracic exposure is performed to obtain immediate proximal control of hemorrhage although aortic balloon occlusion is utilized for resuscitation 22…”

Resuscitative endovascular balloon occlusion of the aorta deployed by acute care surgeons in patients with morbidly adherent placenta: a feasible solution for two lives in peril

“…Within the field of trauma and emergency surgery, acute care surgeons have typically used REBOA in victims of traumatic truncal hemorrhage who present with hemodynamic instability [ 31 – 33 ]. Trauma surgeons are critical care providers and surgical rescuers [ 34 ]; hence, their role in REBOA applicable clinical scenarios has been limited only to those unstable patients who require urgent life-saving surgical interventions.…”