Smaller introducer sheaths for REBOA may be associated with fewer complications

Teeter, William; Matsumoto, Junichi; Idoguchi, Koji; Kon, Yuri; Orita, Tomohiko; Funabiki, Takuzo; Brenner, Megan; Matsumura, Yosuke

doi:10.1097/ta.0000000000001143

Cited by 125 publications

(102 citation statements)

References 17 publications

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“…These study findings corroborate findings from previous studies reporting the safety and feasibility of smaller arterial sheaths 14. Although no complications that required surgical or endovascular treatments arose in the small group, the large sheath group had one case requiring percutaneous transluminal angioplasty and two separate cases of lower limb amputation (female, BMI, 23 kg/m 2 ; 15 Fr ECMO returning cannula, and male, BMI, 31; 5 Fr and 7 Fr sheaths in ipsilateral CFA).…”

Section: Discussionsupporting

confidence: 89%

“…REBOA has been carried out since the early 1990s in Japan and therefore, most EM physicians are familiar with the techniques 912 EM physicians undertake the majority of REBOA procedures in Japan, with comparable complication rates 14. Nevertheless, REBOA is not a routine procedure and complications may be associated with insufficient skill and experience.…”

Section: Discussionmentioning

confidence: 99%

“…After confirmation of haemodynamic stabilisation, physicians partially deflated the balloon in small steps of 1–3 mL, aiming to keep the SBP at >90 mm Hg, to allow distal perfusion (partial REBOA (P-REBOA)) 14. For optional monitoring, the distal arterial pressure was measured to evaluate the visceral organ and lower limb perfusion when the contralateral femoral arterial line was placed.…”

Section: Methodsmentioning

confidence: 99%

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Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan

et al. 2017

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan

et al. 2017

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“…To save the patient’s life, some REBOA-related complications may even be inevitable, although all attempts should be made to avoid any adverse sequelae caused by REBOA-related complications. Some studies reported that small introducer sheaths for REBOA may be associated with fewer complications [27, 29] and that ultrasound should be optimized for REBOA [30]. Moreover, partial or intermittent REBOA should be considered in some cases [31, 32].…”

Section: Discussionmentioning

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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“…Several methods to avoid complications while performing insertions have been reported, such as the insertion method with ultrasonography [6, 7], insertion training with a cadaver [8], and the use of smaller introducer sheaths for REBOA [9]. In fact, it has also been reported that a good outcome was obtained by REBOA in the course of prehospital care for severe pelvic fracture as it can be inserted safely without fluoroscopy [10].…”

Section: Discussionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report

et al. 2017

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BackgroundThe resuscitative endovascular balloon occlusion of the aorta, because of its efficacy and feasibility, has been widely used in treating patients with severe torso trauma. However, complications developing around the site proximal to the occlusion by resuscitative endovascular balloon occlusion of the aorta have almost never been studied.Case presentationA 50-year-old Japanese woman fell from a height of approximately 10 m. At initial arrival, her respiratory rate was 24 breaths/minute, her blood oxygen saturation was 95% under 10 L/minute oxygenation, her pulse rate was 90 beats per minute, and her blood pressure was 180/120 mmHg. Mild lung contusion, hemopneumothorax, unstable pelvic fracture, and retroperitoneal bleeding with extravasation of contrast media were observed in initial computed tomography. As her vital signs had deteriorated during computed tomography, a 7-French aortic occlusion catheter (RESCUE BALLOON®, Tokai Medical Products, Aichi, Japan) was inserted and inflated for aortic occlusion at the first lumbar vertebra level and transcatheter arterial embolization was performed for the pelvic fracture. Her bilateral internal iliac arteries were embolized with a gelatin sponge; however, the embolized sites presented recanalization as coagulopathy appeared. Her bilateral internal iliac arteries were re-embolized by n-butyl-2-cyanoacrylate. The balloon was deflated 18 minutes later. After embolization, repeat computed tomography was performed and a massive hemothorax, which had not been captured on arrival, had appeared in her left pleural cavity. Thoracotomy hemostasis was performed and a hemothorax of approximately 2500 ml was aspirated to search for the source of bleeding. However, clear active bleeding was not captured; resuscitative endovascular balloon occlusion of the aorta may have been the cause of the increased bleeding of the thoracic injury at the proximal site of the aorta occlusion.ConclusionsIt is necessary to note that the use of resuscitative endovascular balloon occlusion of the aorta may increase bleeding in sites proximal to occlusions, even in the case of minor injuries without active bleeding at the initial diagnosis.

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Smaller introducer sheaths for REBOA may be associated with fewer complications

Abstract: Therapeutic/care management, level V.

Cited by 125 publications

References 17 publications

Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan

Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan

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 may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report

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