Resuscitative endovascular balloon occlusion of the aorta in trauma patients in youth

Norii, Tatsuya; Miyata, Shin; Terasaka, Yusuke; Guliani, Sundeep; Lu, Stephen W.; Crandall, Cameron

doi:10.1097/ta.0000000000001347

Cited by 26 publications

(21 citation statements)

References 14 publications

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“…Children are more radiosensitive and have a higher risk of carcinogenesis 22 , therefore clinicians are hesitant to perform pan-scan CT in young children. Treatment procedures frequencies such as operations and interventional radiology are low, which may be due to technical difficulties 23 , and thus conservative management is generally accepted in pediatric trauma patients 24,25 . On the other hand, the trend of diagnostic choice between early and late phase demonstrated that the use of pan-scan CT increased regardless of the reduction of severe pediatric injury (Supplemental Table 3).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan

Aoki

Abe

Saitoh

et al. 2019

Sci Rep

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Limited information exists regarding the epidemiology, patterns of treatment, and mortality of pediatric trauma patients in Japan. To evaluate the characteristics and mortality of pediatric trauma patients in Japan, especially in traffic accidents. This was a retrospective cohort study between 2004 and 2015 from a nationwide trauma registry in Japan. Pediatric trauma patients divided into four age groups: <1 years; 1 ≤ 5 years; 6 ≤ 10 years; and 11 ≤ 15 years. Data on patients’ demographics, trauma mechanism and severity, treatments and in-hospital mortality were analyzed between the groups. There were 15,441 pediatric trauma patients during the study period. Among 15,441 pediatric patients, 779 belonged to the <1 year age group, 3,933 to the 1 ≤ 5 years age group, 5,545 to the 6 ≤ 10 age group, and 5,184 to the 11 ≤ 15 years age group. Male injuries (69%) were more frequent than female injuries. Head injuries (44%) were the most frequent and severe. Traffic accidents were the leading cause of trauma (44%). Overall in-hospital mortality was 3.9% and emergency department mortality was 1.4%. In-hospital mortality was 5.3%, 4.7%, 3.0% and 4.0% for the <1 year, 1 ≤ 5 years, 6 ≤ 10 years, and 11 ≤ 15 years age groups respectively. A total of 57% of all trauma deaths were before or upon arrival at hospital. Traffic accidents for the <1 year age group was the highest category of mortality (15%). The overall in-hospital mortality of Japanese pediatric trauma patients was 3.9% based on the nationwide trauma registry of Japan. The main cause of severe trauma was traffic accidents, especially in patients <1 year of age whose mortality was 15%.

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Section: Discussionmentioning

confidence: 99%

Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan

Aoki

Abe

Saitoh

et al. 2019

Sci Rep

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“…A 12 year review from the Japanese National Database, identified 19,467 pediatric patients under 18 years of age, 54 of which had a REBOA deployed with 15 of those patients under the age of 16. This younger patient cohort demonstrated an overall survival rate of 53.3% compared to 38.5% of the adolescents aged 16–18 years old (3). Other clinical end points such as occlusion time, height, weight, coagulation were not analyzed nor were complications such as embolism, acute kidney injury (AKI), or other ischemic events (3).…”

Section: Introductionmentioning

confidence: 88%

“…This younger patient cohort demonstrated an overall survival rate of 53.3% compared to 38.5% of the adolescents aged 16–18 years old (3). Other clinical end points such as occlusion time, height, weight, coagulation were not analyzed nor were complications such as embolism, acute kidney injury (AKI), or other ischemic events (3). Due to the lack of clinical evidence, the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) device is not yet FDA approved for pediatric patients.…”

Section: Introductionmentioning

confidence: 88%

Morphometric and Physiologic Modeling Study for Endovascular Occlusion in Pediatric Trauma Patients

et al. 2020

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Background- The use of the Resuscitative Endovascular Balloon Occlusion (REBOA) device is expanding in adult trauma. Reports of its use in pediatric patients have been published but no guidelines are established nor has it been FDA approved in pediatric use. Methods- 289 CT scans were reviewed to determine the average aortic diameter at the xyphoid process and umbilicus for each Broselow category. These measurements were the basis of 3D printed aortas using TangoPlus FullCure 930®. These aortas were inserted into a circulatory system model featuring two tracks to simulate thoracic and cerebral perfusion. Sonographic flow meters and pressure monitors were placed throughout and flow and pressure readings were recorded as a REBOA device was inflated in the printed aorta segment. Results- Distal aortic flow and pressure decreased while the cerebral branch demonstrated an inverse increase in flow and pressure with REBOA inflation. An initial delay between inflation and flow occlusion was noted with the initial 50% of volume inflated causing a 10% reduction in flow. The REBOA balloon inflation volumes (cc) for each Broselow Category for zone 1 and 3 are as follows: Black 7.5 & 5.5, Green 6 & 3.5, Orange 5.5 & 3, Blue 5 & 2, White 3 & 1.5 Conclusions- Pediatric patients present with a range of vessel sizes that occlude with a range of REBOA balloon inflation volumes. This study provides a basis to establish initial inflation volumes for REBOA deployment in appropriate pediatric trauma patients.

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“…The use of REBOA in the pediatric population is even more controversial since only isolated reports are available. Apart from a couple of case reports, there is only one study that has evaluated the efficacy of REBOA in pediatric trauma patients [7,15,16]. Previous requirements for using large sheaths (12 Fr) has probably been the reason that REBOA has not been considered in young patients.…”

Section: Discussionmentioning

confidence: 99%

“…The evidence in the pediatric population is even more limited with only one retrospective observational cohort publication from the Japanese Trauma Data Bank. This includes 54 severely injured children and suggests REBOA as a reasonable option in the pediatric population [7].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Resuscitation with Aortic Balloon Occlusion in Pediatric Trauma

Sadeghi¹

2019

JEVTM

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Background The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in resuscitation and trauma management in adults is increasing. However, there is limited data published concerning its use in pediatric patients. Methods We describe a case using REBOA for traumatic hemorrhagic shock in a pediatric patient according to the concept of EndoVascular resuscitation and Trauma Management (EVTM) at Örebro University Hospital in April 2019. Informed consent has been received. Results An 11-year-old boy arrived to the emergency room (ER) after a motor vehicle accident. Due to total hemodynamic collapse, cardiopulmonary resuscitation was initiated with return of spontaneous circulation. Zone 1 total REBOA was successfully performed for 7 minutes while damage control surgery was performed and massive transfusion was initiated to stabilize the patient. The patient survived and returned to almost normal daily activity. Conclusion REBOA for endovascular resuscitation and trauma management may be an additional method for temporary hemodynamic stabilization in pediatric patients and, in this specific patient, was used instead of resuscitative thoracotomy. Keywords: REBOA; Hemorrhage; Hemorrhagic Shock; Endovascular Resuscitation, Pediatric Trauma

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Resuscitative endovascular balloon occlusion of the aorta in trauma patients in youth

Abstract: Epidemiologic study, level III; therapeutic study, level IV.

Cited by 26 publications

References 14 publications

Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan

Epidemiology, Patterns of treatment, and Mortality of Pediatric Trauma Patients in Japan

Morphometric and Physiologic Modeling Study for Endovascular Occlusion in Pediatric Trauma Patients

Endovascular Resuscitation with Aortic Balloon Occlusion in Pediatric Trauma

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