When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport

Snyder, Jason A.; Schuerer, Douglas J.E.; Bochicchio, Grant V.; Hoofnagle, Mark H.

doi:10.1016/j.tcr.2022.100622

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Esta redistribución de flujo, genera cambios fisiológicos aumentando la presión arterial media (PAM) para garantizar la perfusión de órganos vitales sobre el nivel de oclusión, mientras se detiene la hemorragia bajo el nivel de la misma. El interés por este dispositivo ha llevado a su implementación en muchos centros de trauma a nivel mundial y además en múltiples escenarios de emergencia como atención prehospitalaria 7 y hemorragia ginecológica [8][9][10] . Los resultados de diversas investigaciones han mostrado beneficios en esta técnica, con reportes favorables.…”

Section: Introductionunclassified

Balón de resucitación aórtico endovascular (REBOA) para el control de la hemorragia no compresible de torso. Revisión de la evidencia.

et al. 2023

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La Hemorragia no compresible de torso, continua siendo unas de las principales causas de mortalidad del paciente víctima de trauma. El control de este tipo de sangrado, requiere de procedimientos invasivos como la toracotomia de reanimación, la cual se realiza en el paciente “in extremis”.La utilización de REBOA se re-introduce desde el 2011, como una forma de oclusión endovascular de la aorta y con el tiempo ya forma parte de los implementos que cuenta un centro de trauma nivel I. Actualmente REBOA se utiliza dentro del proceso de reanimación, mientras se realiza el control definitivo de un sangrado en el torso, con el fin de aumentar la perfusion de órganos como cerebro y corazón existiendo dos zonas principales de oclusión a nivel aórtico.Múltiples investigaciones se han realizado para encontrar las indicaciones y beneficios de REBOA dentro de la atención integral de un paciente con trauma grave, estando aun estas en desarrollo. La utilización en un paciente con trauma grave se encuentra protocolizada en diferentes pasos que van desde el acceso arterial hasta el seguimiento de la extremidad post retiro del introductor.Por este ultimo punto, REBOA se encuentra dentro de los implementos importantes de la reanimación, sin embargo no reemplaza conceptos básicos como atención integral del paciente politraumatizado, control precoz del sangrado y el control de daños resucitativo. Su implementación requiere de un centro altamente protocolizado y con equipos de trauma establecidos con el objetivo disminuir las complicaciones y optimizar la supervivencia.

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Section: Introductionunclassified

Balón de resucitación aórtico endovascular (REBOA) para el control de la hemorragia no compresible de torso. Revisión de la evidencia.

et al. 2023

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Transition of Resuscitative Endovascular Balloon Occlusion of the Aorta from Zone 3 to Zone 1 to Treat Hemodynamic Collapse during Continued Hemorrhage

et al. 2023

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Introduction Noncompressible torso hemorrhage (NCTH) accounts for most potentially survivable deaths on the battlefield. Treatment of NCTH is challenging, especially in far-forward environments with limited capabilities. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown promise in the care of patients with NCTH. REBOA involves introducing a balloon catheter into the descending aorta in a specific occlusion region (zones 1, 2, or 3) and acts as a hemorrhage control adjunct with resuscitative support. The balloon is placed in zone 3 in the infrarenal aorta for high junctional or pelvic injuries and in zone 1 proximal to the diaphragm for torso hemorrhage. Zone 1 REBOA provides more resuscitative support than zone 3; however, the potential for ischemia and reperfusion injuries is greater with zone 1 than with zone 3 REBOA placement. This study aims to determine the possible benefit of transitioning the REBOA balloon from zone 3 to zone 1 to rescue a patient with ongoing venous bleeding and impending cardiovascular collapse. Materials and Methods Yorkshire male swine (70–90 kg, n = 6 per group) underwent injury to the femoral artery, which was allowed to bleed freely for 60 s, along with a simultaneous controlled venous hemorrhage. After 60 s, the arterial bleed was controlled with hemostatic gauze and zone 3 REBOA was inflated. Five hundred milliliters of Hextend was used for initial fluid resuscitation. The controlled venous bleed continued until a mean arterial pressure (MAP) of 30 mmHg was reached to create an impending cardiovascular collapse. The animals were then randomized into either continued zone 3 REBOA or transition from zone 3 to zone 1 REBOA. Following 30 min, a “hospital phase” was initiated, consisting of cessation of the venous hemorrhage, deflation of the REBOA balloon, and transfusion of one unit of whole blood administered along with saline and norepinephrine to maintain a MAP of 60 mmHg or higher. The animals then underwent a 2-h observation period. Survival, hemodynamics, and blood chemistries were compared between groups. Results No significant differences between groups were observed in hemodynamic or laboratory values at baseline, postinitial injury, or when MAP reached 30 mmHg. Survival was significantly longer in animals that transitioned into zone 1 REBOA (log-rank analysis, P = .012). The average time of survival was 14 ± 10 min for zone 3 animals vs. 65 ± 59 min for zone 1 animals (P = .064). No animals in the zone 3 group survived to the hospital phase. Zone 1–treated animals showed immediate hemodynamic improvement after transition, with maximum blood pressure reaching near baseline values compared to those in the zone 3 group. Conclusions In this swine model of NCTH, hemodynamics and survival were improved when the REBOA balloon was transitioned from zone 3 to zone 1 during an impending cardiovascular collapse. Furthermore, these improved outcome data support the pursuit of additional research into mitigating ischemia–reperfusion insult to the abdominal viscera while still providing excellent resuscitative support, such as intermittent or partial REBOA.

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When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport

Cited by 2 publications

References 10 publications

Balón de resucitación aórtico endovascular (REBOA) para el control de la hemorragia no compresible de torso. Revisión de la evidencia.

Balón de resucitación aórtico endovascular (REBOA) para el control de la hemorragia no compresible de torso. Revisión de la evidencia.

Transition of Resuscitative Endovascular Balloon Occlusion of the Aorta from Zone 3 to Zone 1 to Treat Hemodynamic Collapse during Continued Hemorrhage

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