‘Step Up’ approach to the application of REBOA technology in a rural trauma system

Vernamonti, Jack; Holcomb, John B.; Mick, Nathan W.; Falank, Carolyne; Ontengco, Julianne; Rappold, Joseph F.; Sheppard, Forest R.

doi:10.1136/tsaco-2019-000335

Cited by 15 publications

(30 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 Continued refinement of the application of REBOA in trauma includes the "Step-Up-REBOA" approach, where REBOA is used as a progression of capabilities starting with common femoral artery access to gain actionable hemodynamic monitoring and progressive use of this access to sustain clinical options such as imaging, deliberate operative planning, conservative treatment, hemorrhage control, and resuscitation. 14 The rapidly growing published investigations of REBOA have documented both the potential benefits and limitations of this intervention for NCTH. The most critical limitation to the application of REBOA is prolonged balloon occlusion times that generate severe distal ischemia and subsequent lethal ischemia-reperfusion injury.…”

Section: Introductionmentioning

confidence: 99%

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

Russo

White

Baer

2021

Journal of Surgical Research

View full text Add to dashboard Cite

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a standard adjunct for the management of life-threatening truncal hemorrhage, but the technique is limited by the sequalae of ischemia distal to occlusion. Partial REBOA addresses this limitation, and the recent Food and Drug Administration approval of a device designed to enable partial REBOA will broaden its application. We conducted a systematic review of the available animal and clinical literature on the methods, impacts, and outcomes associated with partial REBOA as a technique to enable targeted proximal perfusion and limit distal ischemic injury. We hypothesize that a systematic review of the published animal and human literature on partial REBOA will provide actionable insight for the use of partial REBOA in the context of future wider clinical implementation of this technique.Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines, we conducted a search of the available literature which used partial inflation of a REBOA balloon catheter. Findings from 22 large animal studies and 14 clinical studies met inclusion criteria.Results: Animal and clinical results support the benefits of partial REBOA including extending the resuscitative window extended safe occlusion time, improved survival, reduced proximal hypertension, and reduced resuscitation requirements. Clinical studies provide practical physiologic targets for partial REBOA including a period of total occlusion followed by gradual balloon deflation to achieve a target proximal pressure and/or target distal pressure.Conclusions: Partial REBOA has several benefits which have been observed in animal and clinical studies, most notably reduced ischemic insult to tissues distal to occlusion and improved outcomes compared with total occlusion. Practical clinical protocols are available for the implementation of partial REBOA in cases of life-threatening torso hemorrhage.

show abstract

Section: Introductionmentioning

confidence: 99%

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

Russo

White

Baer

2021

Journal of Surgical Research

View full text Add to dashboard Cite

show abstract

“…Other new areas under evolution include partial REBOA and intermittent REBOA whereby the balloon is only part inflated or undergoes inflation and deflation cycles. Add to this the novel concept that REBOA is in fact a spectrum of technology whereby common femoral artery access is achieved early either with a 7‐Fr (or maybe even a 5‐Fr with a view to upsizing) and used for initial monitoring. Subsequently the sheath can also be used for interventional radiology, for REBOA or even for extracorporeal membrane oxygenation if required.…”

Section: Competing Interestsmentioning

confidence: 99%

REBOA: Where are we now?

Ellis

2020

Emerg Medicine Australasia

View full text Add to dashboard Cite

“…Significant advances in devices have enabled its use in emergency care environments. Along with these device advances, clinical care approaches which leverage the full spectrum of REBOA-associated technology include: (a) timely invasive arterial monitoring, (b) established femoral artery access, (c) diagnostic imaging and surgical planning, (d) endovascular hemorrhage control, and (e) balloon occlusion to respond to decompensation [5]. This approach, termed "Step-Up REBOA", seeks to utilize the benefits of arterial access and endovascular interventions while avoiding the major limitation of prolonged use of aortic occlusion, distal ischemic injury.…”

Section: Introductionmentioning

confidence: 99%

Flying with a Safety Net: Use of REBOA to Enable Safe Transfer to a Level 1 Trauma Center

Weir¹,

Lee²,

Almroth³

et al. 2022

JEVTM

View full text Add to dashboard Cite

Background: Using Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) during air and ground transport requires coordination among the responding clinical team, transport team, and receiving surgical team. Here, we describe the development of a REBOA transport program in a civilian medical system that demonstrates the value of REBOA as part of the toolkit for safe casualty transport. Methods: The regional REBOA program was developed at St. Anthony Summit Medical Center in a multi-step planning and training process to ensure coordination among the facilities and transport resources during trauma patient care. Retrospective record review was performed on all patients (n=5) that received REBOA for transport from the Level 3 Trauma Center to the Level 1 Trauma Center, since inception of the program in March 2019. Data were gathered from hospital electronic medical records. Results: SASMC has transported five trauma patients under the REBOA program; all successfully arrived at the Level 1 Trauma Center to receive definitive care. The integrated arterial blood pressure monitoring capability in the REBOA catheter provided robust physiologic data to enable data-driven interventions during transport. Conclusion: The REBOA program described here is a model of how REBOA can be used to enable safe transport between levels of care, when, without REBOA, such transport might not be possible. The model is applicable during care of civilian trauma patients and combat casualties, where injured patients are initially treated in a prehospital or Role1/2 environment but require transport to a Level 1 Trauma Center or Role 3+ for definitive care. Keywords: REBOA, non-compressible hemorrhage, patient transport

show abstract

‘Step Up’ approach to the application of REBOA technology in a rural trauma system

Cited by 15 publications

References 16 publications

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

REBOA: Where are we now?

Flying with a Safety Net: Use of REBOA to Enable Safe Transfer to a Level 1 Trauma Center

Contact Info

Product

Resources

About