Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage: A 20-year experience in a Level I trauma center

Pieper, Audrey; Thony, F.; Brun, Julien; Rodière, M.; Boussat, Bastien; Arvieux, C.; Tonetti, Jérôme; Payen, Jean‐François; Bouzat, Pierre

doi:10.1097/ta.0000000000001794

Cited by 74 publications

(51 citation statements)

References 16 publications

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“…Although REBOA is now also one option available for the control of severe infra-diaphragm hemorrhage in trauma patients [29][30][31], as assessed globally, some outcomes are described in which patients undergoing REBOA placement had significantly more severe complications and higher mortality compared with patients not undergoing REBOA [32,33]. Although the number of patients who had placed REBOA was too small to evaluate, REBOA placement had seemed no significant differences from the view point of resuscitation in our current study.…”

Section: Discussionmentioning

confidence: 63%

The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma

et al. 2020

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Background: When resuscitating patients with hemorrhagic shock following trauma, fluid volume restriction and permissive hypotension prior to bleeding control are emphasized along with the good outcome especially for penetrating trauma patients. However, evidence that these concepts apply well to the management of blunt trauma is lacking, and their use in blunt trauma remains controversial. This study aimed to assess the impact of vasopressor use in patients with blunt trauma in severe hemorrhagic shock. Methods: In this single-center retrospective study, we reviewed records of blunt trauma patients with hemorrhagic shock and included patients with a probability of survival < 0.6. Vital signs on arrival, characteristics, examinations, concomitant injuries and severity, vasopressor use and dose, and volumes of crystalloids and blood infused were compared between survivors and non-survivors. Data are described as median (25-75% interquartile range) or number. Results: Forty patients admitted from April 2014 to September 2019 were included. Median Injury Severity Score in survivors vs non-survivors was 41 (36-48) vs 45 (34-51) (p = 0.48), with no significant difference in probability of survival between the two groups (0.22 [0.12-0.48] vs 0.21 [0.08-0.46]; p = 0.93). Despite no significant difference in patient characteristics and injury severity, non-survivors were administered vasopressors significantly earlier after admission and at significantly higher doses. Total blood transfusion amount administered within 24 h after admission was significantly higher in survivors (8430 [5680-9320] vs 6540 [4550-7880] mL; p = 0.03). Max catecholamine index was significantly higher in non-survivors (2 [0-4] vs 14 [10-18]; p = 0.008), and administered vasopressors were terminated significantly earlier (12 [4-26] vs 34 [10-74] hours; p = 0.026) in survivors. Although the variables of severity of the patients had no significant differences, vasopressor use (Odds ratio [OR] = 21.32, 95% confident interval [CI]: 3.71-121.6; p = 0.0001) and its early administration (OR = 10.56, 95%CI: 1.90-58.5; p = 0.005) indicated significant higher risk of death in this study.

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Section: Discussionmentioning

confidence: 63%

The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma

et al. 2020

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“…Our usage of REBOA had the following unique features: shorter occlusion time despite longer time from arrival to the start of balloon occlusion and lower SBP just before REBOA insertion compared with other instances in current literature [11, 13, 14]; the ratio of the patients who underwent REBOA was, low and resuscitative hemostasis had been initiated in five patients before the insertion of REBOA. We had used REBOA based on permissive hypotension [1–4].…”

Section: Discussionmentioning

confidence: 92%

“…Its effectiveness for trauma patients has been evaluated in many large-scale studies [9–13]; however, the evidence base is weak and clear indications are lacking. Furthermore, although the time and place of balloon insertion, zone of balloon inflation, and inflation cutoff time are very important, they are heterogeneous factors [11, 14–18]. In addition, while it has been conceivable that REBOA may be effective in patients with severe trauma when integrated with surgery or interventional radiology (IVR) without delay [9], it remains challenging to successfully perform REBOA in patients with severe multiple torso traumas.…”

Section: Introductionmentioning

confidence: 99%

Effect of resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with multiple severe torso trauma: a retrospective study

et al. 2018

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BackgroundAlthough resuscitative endovascular balloon occlusion of the aorta (REBOA) may be effective in trauma management, its effect in patients with severe multiple torso trauma remains unclear.MethodsWe performed a retrospective study to evaluate trauma management with REBOA in hemodynamically unstable patients with severe multiple trauma. Of 5899 severe trauma patients admitted to our hospital between January 2011 and January 2018, we selected 107 patients with severe torso trauma (Injury Severity Score > 16) who displayed persistent hypotension [≥ 2 systolic blood pressure (SBP) values ≤ 90 mmHg] regardless of primary resuscitation. Patients were divided into two groups: trauma management with REBOA (n = 15) and without REBOA (n = 92). The primary endpoint was the effectiveness of trauma management with REBOA with respect to in-hospital mortality. Secondary endpoints included time from arrival to the start of hemostasis. Multivariable logistic regression analysis, adjusted for clinically important variables, was performed to evaluate clinical outcomes.ResultsTrauma management with REBOA was significantly associated with decreased mortality (adjusted odds ratio of survival, 7.430; 95% confidence interval, 1.081–51.062; p = 0.041). The median time (interquartile range) from admission to initiation of hemostasis was not significantly different between the two groups [with REBOA 53.0 (40.0–80.3) min vs. without REBOA 57.0 (35.0–100.0) min ]. The time from arrival to the start of balloon occlusion was 55.7 ± 34.2 min. SBP before insertion of REBOA was 48.2 ± 10.5 mmHg. Total balloon occlusion time was 32.5 ± 18.2 min.ConclusionsThe use of REBOA without a delay in initiating resuscitative hemostasis may improve the outcomes in patients with multiple severe torso trauma. However, optimal use may be essential for success.

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“…After subsequent duplication removal, primary and secondary screening analysis based on inclusion and exclusion criteria, 105 articles were included in the study (figure 1). 3 11–70 A large proportion of articles were retrospective. 13 studies were case reports, and 10 were prospective observational studies (figure 2).…”

Section: Resultsmentioning

confidence: 99%

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

Bekdache¹,

Paradis

Shen

et al. 2019

Trauma Surg Acute Care Open

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BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is regaining popularity in the treatment of traumatic non-compressible torso bleeding. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic.MethodsCritical search from MEDLINE, EMBASE, BIOSIS, COCHRANE CENTRAL, PUBMED and SCOPUS were conducted from the earliest available dates until March 2018. Evidence-based articles, as well as gray literature at large, were analyzed regardless of the quality of articles.ResultsWe identified 1176 articles related to the topic from all available database sources and 57 reviews from the gray literature search. The final review yielded 105 articles. Quantitative and qualitative variables included patient demographics, study design, study objectives, methods of data collection, indications, REBOA protocol used, time to deployment, zone of deployment, occlusion time, complications, outcome, and the level of expertise at the concerned trauma center.ConclusionGrowing levels of evidence support the use of REBOA in selected indications. Our data analysis showed an advantage for its use in terms of morbidities and physiologic derangement in comparison to other resuscitation measures. Current challenges remain in the selective application, implementation, competency assessment, and credentialing for the use of REBOA in trauma settings. The identification of the proper indication, terms of use, and possible advantage of the prehospital and partial REBOA are topics for further research.Level of evidenceLevel III.

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Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage: A 20-year experience in a Level I trauma center

Abstract: Therapeutic, level IV.

Cited by 74 publications

References 16 publications

The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma

The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma

Effect of resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with multiple severe torso trauma: a retrospective study

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

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