The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry

Abstract

PurposeResuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary stabilization of patients with non-compressible torso hemorrhage. This technique has been increasingly used worldwide during the past decade. Despite the good outcomes of translational studies, clinical studies are divided. The aim of this multicenter-international study was to capture REBOA-specific data and outcomes.MethodsREBOA practicing centers were invited to join this online register, which was established in September 2014. REBOA cases were reported, both retrospective and prospective. Demographics, injury patterns, hemodynamic variables, REBOA-specific data, complications and 30-days mortality were reported.ResultsNinety-six cases from 6 different countries were reported between 2011 and 2016. Mean age was 52 ± 22 years and 88% of the cases were blunt trauma with a median injury severity score (ISS) of 41 (IQR 29–50). In the majority of the cases, Zone I REBOA was used. Median systolic blood pressure before balloon inflation was 60 mmHg (IQR 40–80), which increased to 100 mmHg (IQR 80–128) after inflation. Continuous occlusion was applied in 52% of the patients, and 48% received non-continuous occlusion. Occlusion time longer than 60 min was reported as 38 and 14% in the non-continuous and continuous groups, respectively. Complications, such as extremity compartment syndrome (n = 3), were only noted in the continuous occlusion group. The 30-day mortality for non-continuous REBOA was 48%, and 64% for continuous occlusion.ConclusionsThis observational multicenter study presents results regarding continuous and non-continuous REBOA with favorable outcomes. However, further prospective studies are needed to be able to draw conclusions on morbidity and mortality.

How many patients could benefit from REBOA in prehospital care? A retrospective study of patients rescued by the doctors of the Paris fire brigade

“…Among the inclusion criteria proposed is the prior administration of high dose amine. Recent literature does not report the amine doses which patients could have benefited of before or during REBOA,5 but selecting patients on the amine criteria is justified by the fact that REBOA is used as a last resort therapy, when the benefit–risk ratio is in favour of this exceptional technique.…”

Total resuscitative endovascular balloon occlusion of the aorta causes inflammatory activation and organ damage within 30 minutes of occlusion in normovolemic pigs

“…Premedication, general anesthesia, ventilation, antibiotic prophylaxis and euthanization at the end of the experiment were recently described [21]. However, one difference was that intravenous bolus doses of pethidine (25-50 mg h − 1 ) were used in this study instead of fentanyl infusion.…”

“…The basic surgical preparation and measurements have been recently described in detail [21]. In short, a pulmonary arterial catheter was used for measurements of cardiac output (CO), pulmonary wedge pressure and central venous pressure, and for sampling of mixed venous blood.…”

“…Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an aortic occlusive method using endovascular principles for temporary bleeding control and for increasing perfusion pressure in coronary and cerebral arteries in trauma patients until definitive surgical repair is performed [1][2][3][4][5][6][7][8][9]. The inflammatory response to aortic occlusion is believed to cause multiple organ failure and late mortality secondary to ischemia reperfusion injuries (IRI) [1,[10][11][12][13].…”

“…However, multi-trauma patients are exposed to varying degrees of hypoperfusion and reperfusion, thus complicating the evaluation of the inflammatory response that might be expected from aortic occlusion per se [11,15,16]. To date, multiple clinical studies and translational hemorrhagic models have been conducted describing the effects of REBOA in a state of hemorrhagic shock, but few studies have been performed that capture the effects of REBOA in a non-shock condition and give a detailed description of the changes occurring at as early as 15 min and up to 60 min of occlusion [7,8,[17][18][19][20][21].…”