Resuscitative endovascular balloon occlusion of the aorta as an adjunct for hemorrhagic shock due to uterine rupture: a case report

Okada, Asami; Nakamoto, Osamu; Komori, Maya; Arimoto, Hideki; Rinka, Hiroshi; Nakamura, Hiroaki

doi:10.1002/ccr3.1126

Cited by 16 publications

(20 citation statements)

References 12 publications

(10 reference statements)

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“…Among the studies described, the main benefits of REBOA use were hemorrhage control and elevation of arterial pressure, reducing blood transfusion requirements and allowing patients to reach definitive treatment of injuries [16][17][18][19][20][22][23][24]26,27,29 . We carried out the analysis of this study in a segmented way, considering two large groups:…”

Section: Resultsmentioning

confidence: 99%

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Indicações e resultados para o uso expandido da oclusão ressuscitativa por balão endovascular da aorta - REBOA.

Júnior

Maurício

Costa

et al. 2019

Rev. Col. Bras. Cir.

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RESUMO A oclusão ressuscitativa por balão endovascular da aorta (REBOA) é utilizada para controlar hemorragias não compressíveis do tronco como uma opção menos invasiva e com menos distúrbios fisiológicos quando comparado à toracotomia de emergência com clampeamento da aorta. Isso permite a melhora dos parâmetros hemodinâmicos até que a cirurgia definitiva seja realizada. É utilizada no trauma como uma medida para prevenir o colapso hemodinâmico em pacientes que estão em choque hemorrágico grave, mantendo a perfusão do cérebro e do coração enquanto diminui o sangramento distal até que o controle da hemorragia possa ser realizado. As principais complicações relatadas são insuficiência renal aguda, amputações de membros inferiores e óbitos. O objetivo desse estudo foi avaliar a expansão do uso do REBOA em situações não traumáticas de outras áreas da medicina, assim como, avaliar os resultados obtidos até o momento. Uma pesquisa online do PubMed, Medline e SciELO foi realizada com o termo "REBOA" nos últimos cinco anos, e os artigos incluídos foram os 14 que descrevem especificamente o uso do REBOA para condições não traumáticas. Os resultados sugerem que o uso do REBOA levou a um melhor controle do sangramento e aumento da pressão arterial, reduzindo a necessidade de transfusão de sangue e permitindo que os pacientes sobrevivam ao tratamento definitivo das lesões. Concluindo, o uso expandido do REBOA para emergências não traumáticas parece ser eficaz, mas estudos prospectivos e protocolos bem estabelecidos devem ser desenvolvidos para maximizar os resultados.

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Section: Resultsmentioning

confidence: 99%

“…It was also used to control hemorrhagic shock in pregnant women with MAP (n=4) and control postpartum hemorrhage (n=36) [23][24][25]27 . REBOA was effective in the stabilization of bleeding and in the elevation of systolic arterial pressure 23,24,26,27 . reported thrombotic occlusion of the femoral artery.…”

Section: Obstetric Hemorrhagementioning

confidence: 99%

Indicações e resultados para o uso expandido da oclusão ressuscitativa por balão endovascular da aorta - REBOA.

Júnior

Maurício

Costa

et al. 2019

Rev. Col. Bras. Cir.

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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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“…Abnormality of placental implantation can lead to significant maternal mortality in the parturient period and managing such cases of potential or actual maternal hemorrhage poses a daunting challenge to even the most well equipped obstetric and anesthesia units. Placenta percreta is the most severe form of the disease wherein the invading chorionic villi penetrate the uterine myometrium and involve the serosa, sometimes even involving the surrounding abdominal or pelvic structures, such as the bladder, as this case revealed [5]. The EBOA technique was first described by Lieutenant Colonel Carl W. Hughes in a case series of three critically injured Korean Soldiers in the 1950s [6].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Balloon Occlusion of the Aorta for Placenta Percreta During Cesarean Hysterectomy

David¹,

Shibu²,

Mariam³

et al. 2018

IJCR

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anagement of peripartum hemorrhage consumes large volumes of blood products during resuscitation and surgery. Placenta percreta, in particular, remains a challenge due to the simultaneous involvement of the surrounding organs which can complicate surgery and add to already substantial mortality and morbidity rates [1]. Aortic balloon occlusion has been well described in literature for the management of obstetric hemorrhage [2-4]. The authors present the first known use of endovascular balloon occlusion of the aorta (EBOA) in India to successfully manage a case of placenta percreta. CASE HISTORY 36 year old G6P3A2 at full term with no previous co-morbidities. She was previously diagnosed by magnetic resonance imaging as having placenta percreta with bladder involvement, and crossconsultation between the obstetric, cardiology, and anesthesiology teams was done to plan her peri-operative management. The decision was taken to perform an EBOA with the aims of reduce intra-and post-operative hemorrhage, reducing the need for blood and blood-component therapy, and maintaining stable perioperative hemodynamics. After obtaining written consent, she was taken into our catheterization laboratory where central and arterial lines were inserted under local anesthesia. We placed a quadri-luminal central venous catheter in the right internal jugular vein and arterial lines for blood pressure (BP) monitoring in the left radial and right posterior tibial arteries. She was then prepared for EBOA insertion. She was placed on a tiltable table, and a Cardiff wedge was used to provide a 20° left lateral tilt. Fetal monitors and maternal electrocardiograph monitors were attached, and fetal protection by lead shielding was provided. Under local anesthesia, the right femoral artery was cannulated and an 8-French femoral sheath inserted. This was followed by a 40 ml balloon-tipped catheter (Tyshak II R Percutaneous Transluminal Valvuloplasty Catheter, NuMed Inc) (Figs. 1 and 2) under fluoroscopic guidance. The position and integrity of the balloon were tested by injecting 9 mL of saline mixed with dye and placement was confirmed in zone three of the abdominal aorta just above the bifurcation of the common iliac arteries. On inflation, the balloon was noted to take on the shape of the aortic lumen (Fig. 3), with associated loss of posterior tibial pulse. The balloon was then immediately deflated to prevent fetal compromise. The sheath was secured with sutures and 1000 units of IV heparin administered. Pre-operative arterial blood gas (ABG) analysis was within normal limits. The patient was then moved to the operating theater. Standard monitoring and pre-oxygenation were achieved before induction of anesthesia. Separate arterial BP monitoring was done through the left radial and right posterior tibial arteries. Pulse oximeters were also attached to limbs. Standard anesthesia, intubation, and confirmation were performed before the surgery commencing. Urine output was monitored through a urinary

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Resuscitative endovascular balloon occlusion of the aorta as an adjunct for hemorrhagic shock due to uterine rupture: a case report

Cited by 16 publications

References 12 publications

Indicações e resultados para o uso expandido da oclusão ressuscitativa por balão endovascular da aorta - REBOA.

Indicações e resultados para o uso expandido da oclusão ressuscitativa por balão endovascular da aorta - REBOA.

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

Endovascular Balloon Occlusion of the Aorta for Placenta Percreta During Cesarean Hysterectomy

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