scholarly journals Resuscitative endovascular balloon occlusion of the aorta (REBOA) and endovascular resuscitation and trauma management (EVTM): a paradigm shift regarding hemodynamic instability

2018 ◽  
Vol 44 (4) ◽  
pp. 487-489 ◽  
Author(s):  
Tal Hörer
Keyword(s):  
Paradigm Shift ◽  
Hemodynamic Instability ◽  
Balloon Occlusion ◽  
Trauma Management ◽  
Endovascular Balloon Occlusion

scholarly journals Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study

2020 ◽  
Vol 5 (1) ◽  
pp. e000534
Author(s):  
Hiroyuki Otsuka ◽  
Atsushi Uehata ◽  
Naoki Sakoda ◽  
Toshiki Sato ◽  
Keiji Sakurai ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Severe Trauma ◽  
Balloon Occlusion ◽  
Trauma Management ◽  
The Impact ◽  
Endovascular Balloon Occlusion

BackgroundTrauma management requires a multidisciplinary approach, but coordination of staff and procedures is challenging in patients with severe trauma. In October 2014, we implemented a streamlined trauma management system involving emergency physicians trained in severe trauma management, surgical techniques, and interventional radiology. We evaluated the impact of streamlined trauma management on patient management and outcomes (study 1) and evaluated determinants of mortality in patients with severe trauma (study 2).MethodsWe conducted a retrospective cohort study of 125 patients admitted between January 2011 and 2019 with severe trauma (Injury Severity Score ≥16) and persistent hypotension (≥2 systolic blood pressure measurements <90 mm Hg). Patients were divided into a Before cohort (January 2011 to September 2014) and an After cohort (October 2014 to January 2019) according to whether they were admitted before or after the new approach was implemented. The primary outcome was in-hospital mortality.ResultsCompared with the Before cohort (n=59), the After cohort (n=66) had a significantly lower in-hospital mortality (36.4% vs. 64.4%); required less time from hospital arrival to initiation of surgery/interventional radiology (median, 41.0 vs. 71.5 minutes); and was more likely to undergo resuscitative endovascular balloon occlusion of the aorta (24.2% vs. 6.8%). Plasma administration before initiating hemostasis (adjusted OR 1.49 (95% CI 1.04 to 2.14)), resuscitative endovascular balloon occlusion of the aorta (9.48 (95% CI 1.25 to 71.96)), and shorter time to initiation of surgery/interventional radiology (0.97 (95% CI 0.96 to 0.99)) were associated with significantly lower mortality.DiscussionImplementing a streamlined trauma management protocol improved outcomes among hemodynamically unstable patients with severe multiple trauma.Level of evidenceLevel III.

Stepwise Reperfusion After Zone 1 REBOA: Is Repositioning to Zone 3 a Useful Maneuver?

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Emily M Tibbits ◽  
Guillaume L Hoareau ◽  
Meryl A Simon ◽  
Anders J Davidson ◽  
Erik S DeSoucy ◽  
...  
Keyword(s):  
Critical Care ◽  
Functional Outcomes ◽  
Lactate Concentration ◽  
Hemodynamic Instability ◽  
Balloon Occlusion ◽  
Shed Blood ◽  
Hemodynamic Support ◽  
Support Strategies ◽  
Peak Lactate ◽  
Endovascular Balloon Occlusion

Objectives:  One limitation of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is hemodynamic instability upon balloon deflation due to distal hyperemia and washout of ischemic metabolites.  We sought to determine whether stepwise reperfusion after supraceliac (Zone-1) REBOA by transitioning to infrarenal (Zone-3) occlusion would mitigate the physiologic consequences of balloon deflation and decrease hemodynamic instability. Methods:  Twelve anesthetized swine underwent controlled hemorrhage of 25% blood volume, 45 minutes of Zone-1 REBOA, then resuscitation with shed blood.  Standardized critical care began with deflation of the Zone-1 balloon in all animals, and continued for six hours. Half of the animals were randomly assigned to Zone-3 REBOA for an additional 45 minutes following Zone-1 balloon deflation. Results: There were no differences in physiology at baseline, during the initial 30 minutes of hypotension, or during the 45 minutes of Zone-1 occlusion.  After Zone-1 balloon deflation, there was no difference in proximal mean arterial pressure (pMAP) with or without Zone-3 occlusion, or percentage of critical care time spent within the target pMAP range between 65 and 75 mm Hg.  There were also no significant differences in peak lactate concentration or resuscitation requirements. Conclusions:  In an animal model of hemorrhagic shock and Zone-1 REBOA, subsequent Zone-3 aortic occlusion did not add significant ischemic burden, but it also did not provide significant hemodynamic support.  The effect of this strategy on functional outcomes warrants further study.  Continued investigation is necessary to determine optimal resuscitative support strategies during reperfusion following Zone-1 REBOA. 

scholarly journals A descriptive survey on the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for pelvic fractures at US level I trauma centers

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Stephanie Jarvis ◽  
Michael Kelly ◽  
Charles Mains ◽  
Chad Corrigan ◽  
Nimesh Patel ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Hemodynamic Instability ◽  
Balloon Occlusion ◽  
Pelvic Fractures ◽  
Advanced Trauma Life Support ◽  
Trauma Centers ◽  
Fracture Management ◽  
Level I ◽  
Pelvic Fracture Management ◽  
Endovascular Balloon Occlusion

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is not widely adopted for pelvic fracture management. Western Trauma Association recommends REBOA for hemodynamically unstable pelvic fractures, whereas Eastern Association for the Surgery of Trauma and Advanced Trauma Life Support do not. Method Utilizing a prospective cross-sectional survey, all 158 trauma medical directors at American College of Surgeons-verified Level I trauma centers were emailed survey invitations. The study aimed to determine the rate of REBOA use, REBOA indicators, and the treatment sequence of REBOA for hemodynamically unstable pelvic fractures. Results Of those invited, 25% (40/158) participated and 90% (36/40) completed the survey. Nearly half of trauma centers [42% (15/36)] use REBOA for pelvic fracture management. All participants included hemodynamic instability as an indicator for REBOA placement in pelvic fractures. In addition to hemodynamic instability, 29% (4/14) stated REBOA is used for patients who are ineligible for angioembolization, 14% (2/14) use REBOA when interventional radiology is unavailable, 7% (1/14) use REBOA for patients with a negative FAST. Fifty percent (7/14) responded that hemodynamically unstable pelvic fractures exclusively indicates REBOA placement. Hemodynamic instability for pelvic fractures was most commonly defined as systolic blood pressure of < 90 [56% (20/36)]. At centers using REBOA, REBOA was the first line of treatment for hemodynamically unstable pelvic fractures 40% (6/15) of the time. Conclusions There is little consensus on REBOA use for pelvic fractures at US Level I Trauma Centers, except that hemodynamically unstable pelvic fractures consistently indicated REBOA use.

Successful Control of Massive Vaginal Bleeding with Resuscitative Endovascular Balloon Occlusion of the Aorta and Pelvic Packing

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Emre Özlüer ◽  
Çagaç Yetis ◽  
Evrim Sayin ◽  
Mücahit Avcil
Keyword(s):  
Vaginal Bleeding ◽  
Balloon Occlusion ◽  
Emergency Physicians ◽  
Pelvic Packing ◽  
Gynecological Malignancies ◽  
Life Threatening ◽  
Successful Control ◽  
Endovascular Balloon Occlusion

Gynecological malignancies may present as life-threatening vaginal bleeding. Pelvic packing and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful along with conventional vaginal packing when in terms of control of the hemorrhage. Emergency physicians should be able to perform these interventions promptly in order to save their patients from exsanguination.

AORTA Registry 7F vs 11-12 F access

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Reviewer Joseph DuBose ◽  
Jonathan Morrison ◽  
Megan Brenner ◽  
Laura Moore ◽  
John B Holcomb ◽  
...  
Keyword(s):  
Ultrasound Guidance ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Severely Injured ◽  
Distal Extremity ◽  
Low Profile ◽  
Transfusion Requirements ◽  
Thrombotic Complications ◽  
Device Use ◽  
Endovascular Balloon Occlusion

ABSTRACT Introduction:  The introduction of low profile devices designed for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) after trauma has the potential to change practice, outcomes and complication profiles related to this procedure. Methods: The AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was utilized to identify REBOA patients from 16 centers -comparing presentation, intervention and outcome variables for those REBOA via traditional 11-12 access platforms and trauma-specific devices requiring only 7 F access. Results:From Nov 2013-Dec 2017, 242 patients with completed data were identified, constituting 124 7F and 118 11-12F uses. Demographics of presentation were not different between the two groups, except that the 7F patients had a higher mean ISS (39.2 34.1, p = 0.028). 7F device use was associated with a lower cut-down requirement for access (22.6% vs. 37.3%, p = 0.049) and increased ultrasound guidance utilization (29.0% 23.7%, p = 0.049). 7F device afforded earlier aortic occlusion in the course of resuscitation (median 25.0 mins vs. 30 mins, p = 0.010), and had lower median PRBC (10.0 vs. 15.5 units, p = 0.006) and FFP requirements (7.5 vs. 14.0 units, p = 0.005). 7F patients were more likely to survive 24 hrs (58.1% vs. 42.4%, p = 0.015) and less likely to suffer in-hospital mortality (57.3% vs. 75.4%, p = 0.003). Finally, 7F device use was associated with a 4X lower rate of distal extremity embolism (20.0% vs. 5.6%, p = 0.014;OR 95% CI 4.25 [1.25-14.45]) compared to 11-12F counterparts. Conclusion: The introduction of trauma specific 7F REBOA devices appears to have influenced REBOA practices, with earlier utilization in severely injured hypotensive patients via less invasive means that are associated with lower transfusion requirements fewer thrombotic complications and improved survival. Additional study is required to determine optimal REBOA utilization.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) enables operative management of the peripartum trauma patient in hemorrhagic shock

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Kelvin Allenson ◽  
Laura Moore
Keyword(s):  
Maternal Death ◽  
Motor Vehicle ◽  
Operative Management ◽  
Balloon Occlusion ◽  
Motor Vehicle Accidents ◽  
Gravid Uterus ◽  
Intrauterine Pregnancy ◽  
Vehicle Accidents ◽  
Pelvic Hemorrhage ◽  
Endovascular Balloon Occlusion

Trauma related injury is the leading cause of non-obstetric maternal death.  The gravid uterus is at risk for injury, particularly during motor vehicle accidents.  Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a means of controlling pelvic hemorrhage in the setting of trauma.  We report the use of REBOA in a hemodynamically unstable, multiply-injured young woman with viable intrauterine pregnancy.

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Valentina Chiarini
Keyword(s):  
Trauma Center ◽  
Aortic Rupture ◽  
Damage Control ◽  
Aortic Injury ◽  
Balloon Occlusion ◽  
Traumatic Lesion ◽  
Abdominal Aortic ◽  
Aortic Injuries ◽  
Accepted Practice ◽  
Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

Use of ER-REBOA to Reverse Traumatic Arrest After Non-Truncal Bleeding

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
M. Chance Spalding ◽  
Matthew L Moorman ◽  
John B Holcomb
Keyword(s):  
Cardiac Arrest ◽  
Balloon Occlusion ◽  
Successful Case ◽  
Endovascular Balloon Occlusion

We report a successful case of resuscitative endovascular balloon occlusion of the aorta (REBOA) to control hemorrhage in a patient with cardiac arrest secondary to non-truncal hemorrhage.

scholarly journals Aktuelle Ist-Analyse zur Situation des nichttraumatologischen Schockraummanagements in Deutschland

2020 ◽  
Author(s):  
M. Michael ◽  
S. Bax ◽  
M. Finke ◽  
M. Hoffmann ◽  
S. Kornstädt ◽  
...  
Keyword(s):  
Chest Compression ◽  
Balloon Occlusion ◽  
Kritisch Kranke Patienten ◽  
Compression Device ◽  
Kritisch Kranke ◽  
E Mail ◽  
Endovascular Balloon Occlusion

Zusammenfassung Einleitung In Notaufnahmen kommen bundesweit nichttraumatologische kritisch kranke Patienten zur Aufnahme. Zur Struktur, Organisation und Ausstattung des nichttraumatologischen Schockraummanagements ist bisher wenig bekannt. Mittels einer Umfrage sollte daher der Ist-Zustand analysiert werden. Methodik Durch die Arbeitsgruppe „Schockraum“ der Deutschen Gesellschaft Interdisziplinäre Notfall- und Akutmedizin (DGINA) wurde mittels E‑Mail den 420 ärztlichen Leiter*Innen des DGINA-Mitgliederregisters eine Onlineumfrage zugesendet. Zwei Wochen nach initialem Anschreiben erfolgte eine Erinnerung. Die Ergebnisse wurden in einer anonymisierten Datenbank extrahiert und ausgewertet. Ergebnisse Insgesamt lag die Rücklaufquote mit 131 verwertbaren Antworten bei 31 %. Die Umfrage erfasste Krankenhäuser der Basis- (24 %), erweiterten (39 %) und umfassenden Notfallversorgung (37 %). Korrespondierend zur Versorgungsstufe stiegen die jährlichen Patientenkontakte (21.000 vs. 31.000 vs. 39.000), die Monitorplätze in den Notaufnahmen (9 ± 4 vs. 13 ± 6 vs. 18 ± 10), die Betten der assoziierten Notaufnahmestationen (4 ± 5 vs. 10 ± 17 vs. 13 ± 12), die verfügbaren Schockräume (1 ± 1 vs. 2 ± 1 vs. 3 ± 1) und deren Größe (31 ± 16 vs. 35 ± 9 vs. 38 ± 14 m2) an. Hinsichtlich verschiedener Ausstattungsmerkmale (z. B. Röntgenlafette: 58 vs. 65 vs. 78 %, Computertomographie im Schockraum: 6 vs. 12 vs. 27 %) zeigten sich deutliche Unterschiede in Abhängigkeit von der Versorgungsstufe. Während Kühlungssysteme in 30 % in allen Versorgungsstufen vorgehalten wurden, fanden sich andere Ausstattungsmerkmale (z. B. Videolaryngoskopie: 65 vs. 80 vs. 86 %, Bronchoskopie: 29 vs. 22 vs. 45 %) und spezielle Notfallprozeduren (z. B. REBOA [„resuscitative endovascular balloon occlusion of the aorta“]: 3 vs. 5 vs. 12 %, ACCD [„automated chest compression device“]: 26 vs. 57 vs. 61 %) häufiger in höheren Versorgungsstufen. Schlussfolgerung Die vorliegenden Ergebnisse zeigen erstmals den Ist-Zustand der nichttraumatologischen Schockraumversorgung in verschiedenen Versorgungsstufen in Deutschland. Empfehlungen zu Ausstattungsmerkmalen für das nichttraumatologische Schockraummanagement müssen zukünftig formuliert werden.

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