Resuscitative Endovascular Balloon Occlusion of the Aorta: Implementation and Preliminary Results at an Academic Level I Trauma Center

Darrabie, Marcus D.; Croft, Chasen A.; Brakenridge, Scott C.; Mohr, Alicia M.; Rosenthal, Martin; Mercier, Nicole R.; Moore, Frederick A.; Smith, R. Stephen

doi:10.1016/j.jamcollsurg.2018.03.042

Cited by 37 publications

(33 citation statements)

References 19 publications

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“…Together with other endovascular procedures such as embolization and interprofessional care concepts (e.g. trauma hybrid operating room and resuscitation with angiography, percutaneous techniques and operative repair) [32,[70][71][72][73], REBOA could become an additional important pillar for treatment of hemorrhage in severely injured patients, especially if resuscitative thoracotomy is not immediately available. Conflicts of interest J.K., E.P.…”

Section: Resultsmentioning

confidence: 99%

“…Because of low incidence rates even in major trauma centers (i.e. 1-2 cases per year per level I trauma center in the United Kingdom [30] or Germany [31]), suitable training programmes for all members of the trauma team must be organized, with special emphasis on local equipment and standards [32][33][34] (c.f. Figure 2a-h) [34].…”

Section: Endovascular Balloon Occlusion Of the Aorta Preparationmentioning

confidence: 99%

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Resuscitative endovascular balloon occlusion of the aorta

Kulla

Popp

Knapp

2019

Current Opinion in Anaesthesiology

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Purpose of review Hemorrhage is the major cause of early death in severely injured patients. In civilian emergency medical services, the majority of life-threatening bleedings are found in noncompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a possible lifesaving procedure and numerous studies, meta-analyses and guidelines have been published. In this review, the data situation of REBOA in the management of bleeding trauma patients is discussed and practical implementation is depicted. Recent findings The typical indication for REBOA is a traumatic life-threatening hemorrhage below the diaphragm in patients unresponsive or only transiently responsive to the usual conservative therapeutic measures. REBOA appears to be a safe and effective procedure to reduce blood loss and stabilize the patient's hemodynamic status. However, surgical hemostasis has to be achieved within 30-60 min after occlusion of the aorta. Data on clear advantages of REBOA over resuscitative thoracostomy are inconclusive. Summary REBOA could play an important role in the management of the severely bleeding patient in the future. Together with transfusion and therapy of coagulation disorders, REBOA may be an additional tool in the anesthetist's hands for trauma management in interprofessional care concepts.

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Section: Resultsmentioning

confidence: 99%

Section: Endovascular Balloon Occlusion Of the Aorta Preparationmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta

Kulla

Popp

Knapp

2019

Current Opinion in Anaesthesiology

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“…However, intra-aortic balloon occlusion, the predecessor of REBOA, was first reported by Hughes during the Korean War in 1954 and has since been widely applied in situations such as arrest, sub-diaphragmatic hemorrhage, combat casualties, and pre-hospital management [16]. In fact, according to previous studies, the mortality rate of severely injured patients who received REBOA was 47.1-90.4%, which was significantly lower than those treated using other techniques, such as thoracotomy [3,4,[17][18][19][20]. Our study did not compare a REBOA group with a non-REBOA group, but reported a total mortality rate of 76.2%, which is not meaningfully different from the rates reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Hemorrhagic shock is the leading cause of potentially preventable death in trauma patients worldwide [1,2]. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for improving the hemodynamic stability of patients with traumatic shock, maintaining brain and coronary artery perfusion, and temporarily controlling arterial hemorrhage [3,4], This procedure can also be used as an alternative to resuscitative thoracotomy [5]. A recent report discussed the use of REBOA in trauma patients and concluded that REBOA is a technically feasible method of rapid aortic occlusion for the resuscitation of patients experiencing hemorrhagic shock due to abdominal or pelvic bleeding [6,7].…”

Section: Introductionmentioning

confidence: 99%

Resuscitative Endovascular Balloon occlusion of the aorta in Impending Traumatic arrest: Is It Effective?

Chung

Kim

et al. 2020

J Trauma Inj

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Purpose: Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations. methods: This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups. results: We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%. Conclusions: Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.

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“…A 20‐year review from France strongly supported REBOA . 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 .…”

Section: Competing Interestsmentioning

confidence: 90%

REBOA: Where are we now?

Ellis

2020

Emerg Medicine Australasia

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Resuscitative Endovascular Balloon Occlusion of the Aorta: Implementation and Preliminary Results at an Academic Level I Trauma Center

Cited by 37 publications

References 19 publications

Resuscitative endovascular balloon occlusion of the aorta

Resuscitative endovascular balloon occlusion of the aorta

Resuscitative Endovascular Balloon occlusion of the aorta in Impending Traumatic arrest: Is It Effective?

REBOA: Where are we now?

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