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

Manzano-Núñez, Ramiro; Escobar-Vidarte, María Fernanda; Orlas, Claudia; Herrera-Escobar, Juan P.; Galvagno, Samuel M.; Meléndez, Juan J.; Padilla, Natalia; McCarty, Justin C; NIETO, A.L. SOLANO; Ordóñez, Carlos A.

doi:10.1186/s13017-018-0205-2

Cited by 32 publications

(26 citation statements)

References 40 publications

(57 reference statements)

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“…These modalities include additional pharmacological agents and blood products, uterine artery embolization, arterial balloon occlusion, or hysterectomy. Balloon occlusion of the bilateral internal iliac arteries and the abdominal aorta has been used to reduce blood loss [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Resuscitative Endovascular Balloon Occlusion of the Aorta and Concomitant Tranexamic Acid for Cesarean Hysterectomy Complicated by Common Femoral Artery Thrombosis: A Case Report

Herbert

Buchbinder

Seshachellam

et al. 2020

Cureus

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With increasing cesarean delivery rates, placenta accreta spectrum (PAS) disorders are occurring more frequently and represent a significant cause of peripartum hemorrhage. Different modalities have been explored to control blood loss during cesarean hysterectomies for PAS disorders, including administration of tranexamic acid (TXA) and balloon occlusion strategies. We present a case of a cesarean hysterectomy for a placenta percreta with the use of TXA and arterial balloon occlusion complicated by a lower extremity arterial thrombus requiring emergent thrombectomy. The outcome of this case suggests using caution with concomitant use of TXA and arterial balloon occlusion.

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Section: Introductionmentioning

confidence: 99%

Resuscitative Endovascular Balloon Occlusion of the Aorta and Concomitant Tranexamic Acid for Cesarean Hysterectomy Complicated by Common Femoral Artery Thrombosis: A Case Report

Herbert

Buchbinder

Seshachellam

et al. 2020

Cureus

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“…REBOA is a minimally invasive procedure that introduces a balloon occlusion catheter via a percutaneous groin puncture or cutdown of the femoral artery into the aorta to obtain endovascular aortic occlusion [13,14] . REBOA has been used clinically for the treatment of abdominal aortic aneurysm and related obstetric diseases [15,16] , but now it has been widely used for the hemostatic treatment of bleeding at NCTH.…”

Section: Discussionmentioning

confidence: 99%

Resuscitative Endovascular Balloon Occlusion of the Aorta（REBOA） in A Swine Model of Iliac Artery Hemorrhage under the Guidance of Portable Ultrasound

Huang

Shan²,

Wu³

et al. 2021

Preprint

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Background: The major challenge of applying Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pre-hospital setting is to accurately place the balloon in. To evaluate the effects of applying portable ultrasound to guide REBOA for iliac artery hemostasis.Methods: We first established a swine model of hemorrhage by percutaneously puncture the right iliac artery under the guidance of portable ultrasound. Then we randomly divided the swine into two groups. We recorded systolic pressure (SP), diastolic pressure (DP), heart rate (HR), and the maximum depth of the ascites at baseline (T1), free bleeding for the 30s (T2), bleeding for 10min (T3), and bleeding for 30min (T4). Immediately after T2, we performed REBOA under the guidance of portable ultrasound in the intervention group and manual extracorporeal compression by dry gauze in the control group. We collected total blood loss at T4.Results: There were 11 swine included in the analysis (intervention group=6, control group=5). The characteristics of the two groups were similar at T1. After punctured the right iliac artery, hemorrhagic shock appeared in both groups at T2 - BP and DP fell, HR elevated, and the maximum depth of the ascites increased. After performing REBOA, SP(in mmHg) in the intervention group significantly increased to 97.17±11.92 at T3 and remained stable throughout T4; while SP in the control group kept decreasing and reached 62.40±3.44 at T4. A similar trend was found in DP. HR(in bpm) in the intervention group increased from 101.50±5.39 in T2 to 111.83±7.39 in T3 and stabilized at 113.83±5.49 in T4; in the control group, it kept increasing from 103.20±3.70 in T2 to 132.40±3.98 in T4. The maximum depth of the ascites increased between T2 and T4 in both groups, but significantly slower in the intervention group (at T4 3.50±0.36cm vs 5.14±0.35cm, P<0.05). The total blood loss was significantly less in the intervention group (1245.23±190.07g) than in the control group (2605.63±291.67g).Conclusions: Performing REBOA under the guidance of portable ultrasound can improve the effectiveness of iliac artery hemostasis and have great potential to save lives in pre-hospital settings.

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“…Trauma and vascular surgeons [1][2][3][4][5][6][7][8][9][10], emergency physicians [23,24] and prehospital providers [25,26] are using REBOA with increasing frequency. It is being deployed in both trauma patients as well as those with intraabdominal hemorrhage of non-traumatic etiology [27][28][29][30][31][32]. Although the technical process of placing a REBOA catheter in a patient is straightforward, multiple factors must be in place to ensure a given institution is wellequipped to best utilize the technology.…”

Section: Discussionmentioning

confidence: 99%

Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course

Theodorou

Salcedo

DuBose

et al. 2020

JEVTM

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Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is emerging as a viable intervention for hemorrhagic shock. Training surgeons to place the device is only part of the process. We hypothesize that implementation challenges extend beyond surgical skills training and initial REBOA use should not be expected to mirror published success.Methods:All REBOA placements from January 2016-February 2017 at a level 1 trauma center were reviewed for opportunities for improvement (OFI). From September 2016-February 2017 all patients meeting highest trauma activation criteria were reviewed against our REBOA algorithm to identify patients meeting criteria for REBOA placement but not undergoing the procedure.Results:REBOA was introduced at our institution in September 2015, with first placement in January 2016. Trauma surgery, Emergency Department, and Operating Room staff underwent training. Nine patients had REBOA placed with six survivors. One patient underwent unsuccessful REBOA attempt and died. Four patients had complications from REBOA. Eight additional patients met indications but did not undergo REBOA. Conclusion:Successful REBOA use requires more than teaching surgeons indications and techniques. For a successful REBOA program, systems factors must be addressed. Systems processes must ensure equipment and procedures are standardized and familiar to all involved. Complications should be expected.

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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

Cited by 32 publications

References 40 publications

Resuscitative Endovascular Balloon Occlusion of the Aorta and Concomitant Tranexamic Acid for Cesarean Hysterectomy Complicated by Common Femoral Artery Thrombosis: A Case Report

Resuscitative Endovascular Balloon Occlusion of the Aorta and Concomitant Tranexamic Acid for Cesarean Hysterectomy Complicated by Common Femoral Artery Thrombosis: A Case Report

Resuscitative Endovascular Balloon Occlusion of the Aorta（REBOA） in A Swine Model of Iliac Artery Hemorrhage under the Guidance of Portable Ultrasound

Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course

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