The management of patients with placenta percreta: A case series comparing the use of resuscitative endovascular balloon occlusion of the aorta with aortic cross clamp

Stubbs, M; Wellbeloved, M A; Vally, Janine C

doi:10.4103/ija.ija_121_20

Cited by 6 publications

(3 citation statements)

References 10 publications

(21 reference statements)

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“…The reported data combine both prophylactic and emergent placements of REBOA, with reported studies conducted outside the USA. [18][19][20][21] Ordoñez et al 21 reported on the experience at a Colombian level I trauma center which prophylactically used REBOA in 12 women undergoing an elective cesarean section for morbid placentation with a median estimated blood loss (EBL) of 1500 mL. The authors found the use of REBOA decreased intraoperative blood loss and the number of PRBCs transfused, without REBOA-associated complications.…”

Section: Open Accessmentioning

confidence: 99%

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When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders

Ioffe

Burruss

Yao

et al. 2021

Trauma Surg Acute Care Open

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BackgroundPatients with placenta accreta spectrum (PAS) disorders often suffer massive hemorrhage during cesarean hysterectomies (CHyst). A novel strategy to decrease blood loss and minimize perioperative morbidity associated with PAS is utilization of ER-REBOA Catheter intraoperatively. In this study, we explore the use of ER-REBOA Catheter during CHyst with the goal of minimizing perioperative morbidity and packed red blood cell (PRBC) transfusions.MethodsWe conducted a retrospective case–control study at a regional referral center of consecutive patients with PAS undergoing CHyst. The primary outcomes were PRBC transfusions of ≥4 units. Secondary outcomes included surgical intensive care unit admissions, postoperative length of stay (LOS), postoperative ileus, and vascular complication rate. We also explored utilization of manual palpation and omission of precesarean fluoroscopy for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement verification in distal aortic zone 3.Results90 patients were included in the study. REBOA and non-REBOA cases were similar in clinicodemographic characteristics. 17.7% of REBOA cases received ≥4 units of PRBC compared with 49.3% of non-REBOA cases (p=0.03). Zero REBOA patients developed postoperative ileus, whereas 18 (25%) non-REBOA patients did (p=0.02). LOS was reduced in the REBOA group. Postplacement fluoroscopy was omitted in all REBOA cases. Two postoperative arterial thrombotic events (2 of 19, 11% of REBOA patients) were identified in the REBOA group, one requiring a thrombectomy (1 of 19, 5%).DiscussionDecrease in blood transfusions of ≥4 units of PRBC is demonstrated when ER-REBOA Catheter is placed in distal aortic zone 3 during CHyst performed for severe PAS disorders. The incidence of postoperative ileus and LOS are reduced in the ER-REBOA Catheter group. Placement and utilization of ER-REBOA Catheter during CHyst may be feasible without fluoroscopy when manual placement verification is performed by an experienced operator. Protocol modifications focusing on reducing thrombotic rate are ongoing.Level of evidenceIV.

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Section: Open Accessmentioning

confidence: 99%

“…The reported data combine both prophylactic and emergent placements of REBOA, with reported studies conducted outside the USA. 18–21 …”

Section: Introductionmentioning

confidence: 99%

When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders

Ioffe

Burruss

Yao

et al. 2021

Trauma Surg Acute Care Open

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“…Although neuraxial anaesthesia (NA) has advantages over other surgical techniques among pregnant woman in terms of the risk of maternal pulmonary aspiration and neonatal results,[ 1 ] general anaesthesia (GA) is routinely used as the standard anaesthetic method in some centres for PAS patients. [ 2 3 ] This is especially true in developing countries where the availability of PAS fixed multidisciplinary teams (PAS team) are often lacking. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Placenta accreta spectrum anaesthetic management with neuraxial technique can be facilitated by multidisciplinary groups

López-Erazo¹,

Sánchez²,

Blanco³

et al. 2021

Indian J Anaesth

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Background: The concern about massive haemorrhage associated with placenta accreta spectrum (PAS) prompts the routine use of general anaesthesia (GA) at many centres. We aimed to describe the effects of establishing a fixed multidisciplinary team (PAS team) on anaesthetic practices and clinical results. Methods: In this before-and-after study, we included patients with prenatal PAS suspicion treated between December 2011 and December 2019. We evaluated the anaesthetic techniques used before (Group 1) and after (Group 2) a PAS team was established. Results: Eighty-one patients were included. Neuraxial anaesthesia (NA) was used in 23.3% of group 1 patients and 76.4% of group 2 patients. Likewise, the frequency of conversion to GA after initial management with NA decreased from 14.3% in group 1 to 7.7% in group 2. Conclusions: The establishment of a PAS team is related to increased use of NA during the management of PAS patients.

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Current Approaches to Resuscitative Endovascular Balloon Occlusion of the Aorta Use in Trauma and Obstetrics

Lee

Potnuru

Stephens

et al. 2021

Advances in Anesthesia

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The management of patients with placenta percreta: A case series comparing the use of resuscitative endovascular balloon occlusion of the aorta with aortic cross clamp

Cited by 6 publications

References 10 publications

When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders

When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders

Placenta accreta spectrum anaesthetic management with neuraxial technique can be facilitated by multidisciplinary groups

Current Approaches to Resuscitative Endovascular Balloon Occlusion of the Aorta Use in Trauma and Obstetrics

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