Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

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Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Management of Trauma Patients: A Systematic Literature Review

The American Surgeon ◽

10.1177/000313481908500631 ◽

2019 ◽

Vol 85 (6) ◽

pp. 654-662 ◽

Cited By ~ 2

Author(s):

Patrizio Petrone ◽

Aida PÉRez-JimÉNez ◽

Martín Rodríguez-Perdomo ◽

Collin E. M. Brathwaite ◽

D'andrea K. Joseph

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Single Case ◽

Case Reports ◽

Balloon Occlusion ◽

Definitive Treatment ◽

Trauma Patients ◽

Aortic Balloon Occlusion ◽

Number Of Patients ◽

Endovascular Balloon Occlusion

Resuscitative endovascular balloon occlusion of the aorta (REBOA) represents an innovative method by which noncompressible bleeding in the torso can be mitigated until definitive treatment can be obtained. To perform a systematic review of the literature on the use of the REBOA in trauma patients. An English and Spanish literature search was performed using MEDLINE, PubMed, and Scopus, from 1948 to 2018. Keywords used were aortic balloon occlusion, resuscitative endovascular balloon, REBOA, hemorrhage, and resuscitative endovascular balloon occlusion of the aorta. The eligilibility criteria included only original and human subject articles. Nontrauma patients, nonbleeding pathology, letters, single case reports, reviews, and pediatric patients were excluded. Two hundred forty-six articles were identified, of which 17 articles were included in this review. The total number of patients was 1340; 69 per cent were men and 31 per cent women. In 465 patients, the aortic zone location was described: 83 per cent the balloon was placed in aortic zone I and 16 per cent in zone III. Systolic blood pressure increased at an average of 52 mmHg before and after aortic occlusion. Although 32 patients (2.4%) presented clinical complications derived from the procedure, no mortality was reported. The trauma-related mortality rate was 58 per cent (776/1340). REBOA is a useful resource for the management of non-compressive torso hemorrhage with promising results in systolic blood pressure and morbidity. Indications for its use include injuries in zones 1 and 3, whereas it is not clear for zone 2 injuries. Additional studies are needed to define the benefits of this procedure.

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Systolic blood pressure below 110mmHg is associated with increased mortality in penetrating major trauma patients: Multicentre cohort study

Resuscitation ◽

10.1016/j.resuscitation.2011.10.018 ◽

2012 ◽

Vol 83 (4) ◽

pp. 476-481 ◽

Cited By ~ 54

Author(s):

Rebecca M. Hasler ◽

Eveline Nüesch ◽

Peter Jüni ◽

Omar Bouamra ◽

Aristomenis K. Exadaktylos ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Systolic Blood Pressure ◽

Major Trauma ◽

Trauma Patients ◽

Multicentre Cohort Study ◽

Multicentre Cohort

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Liver transplantation: a 10-year single center experience in Pernambuco- northeastern Brazil

Brazilian Journal of Transplantation ◽

10.53855/bjt.v13i2.227 ◽

2010 ◽

Vol 13 (2) ◽

pp. 1288-1292

Author(s):

Luiz Eduardo C. Miranda ◽

Paulo Sérgio Vieira de Melo ◽

Diego Laurentino Lima ◽

Bernardo Sabat ◽

Américo Gusmão Amorim ◽

...

Keyword(s):

Liver Transplantation ◽

Survival Curve ◽

Deceased Donor ◽

Conventional Technique ◽

University Hospital ◽

Northeastern Brazil ◽

Organ Shortage ◽

Single Center ◽

Liver Donor ◽

Single Center Experience

Purpose: The aim of this study is to analyze a ten-year single center experience in liver transplantation in Pernambuco - Northeastern region of Brazil. Methods: Data were retrospectively collected from medical records of 302 patients who underwent Orthotopic Liver Transplantation (OLT) between 1998 and 2008 at Oswaldo Cruz University Hospital, Pernambuco – Brazil. We analyzed just the outcomes and survival curve of 195 adult liver transplantation recipients from deceased donor. Results: Data concern liver donor, surgery technical aspects and liver transplantation recipients’ postoperative evolution are presented and discussed. This center has a significant experience in liver transplantation using conventional technique with no venovenous bypass. Efficient management of liver transplantation practice has made it feasible to keep the cold ischemia time within 6-7 hours. Because of the organ shortage, we have used a large amount of extended criteria liver donor. The survival 1-year rata was 76.4%. Conclusion: It is possible to provide a high-quality public medical assistance in an efficient and continuous manner in less developed areas of Brazil.

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23. Ambulance Sphygmomanometer Accuracy: Can It Affect Triage to the Trauma Center?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00045726 ◽

1996 ◽

Vol 11 (S2) ◽

pp. S33-S33

Author(s):

Charles E. Cady ◽

Ronald G. Pirrallo ◽

Clarence E. Grim

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Blunt Trauma ◽

Frequency Distribution ◽

Trauma Center ◽

Trauma Patients ◽

Cross Sectional ◽

Industry Standards ◽

Study Population ◽

The Mean

Objectives: To determine the accuracy of sphygmomanometers (SPHYGs) from a metropolitan EMS system and quantitate the mis-triage of adult blunt trauma patients based on erroneous systolic blood pressure (SBP) readings.Methods-A: A cross-sectional, convenient sample of 150 SPHYGs was checked for accuracy using industry standards. Mean high and low deviations were calculated at 90 mmHg.Methods-B: Retrospectively, a frequency distribution of the initial SBPs of all blunt trauma patients, age ≥21, seen in 1994 was plotted to characterize our study population. The numbers of patients potentially over- or under-triaged were identified when their reported SBP was corrected for using the mean high and low deviation plus 2 SDs.Results-A: Overall, 25.3% of the SPHYGs were inaccurate. At 90 mmHg, 28.0% (42/150) were inaccurate with 16.7% (7/42) high by 4.6±1.5 mmHg and 81.0% (34/42) low by 6.2±4.2 mmHg; one was inoperable.Results-B: 1,005 adult blunt trauma patients were evaluated; 61 were eliminated: 35 had initial SBPs of 0 mmHg and 26 had no SBP recorded (n = 944). The mean initial SBP was 138 ±30mmHg, and 3.8% (36/944) of the patients had SBPs <90 mmHg. Potentially, 2.0% (19/944) of the patients were undertriaged (initial erroneously high SBP reading 90–98 mmHg) and 2.5% (24/944) over-triaged (initial erroneously low SBP reading 74–90 mmHg).

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Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy

Scandinavian Journal of Surgery ◽

10.1177/1457496919828244 ◽

2019 ◽

Vol 109 (2) ◽

pp. 89-95 ◽

Cited By ~ 1

Author(s):

J. Kosola ◽

T. Brinck ◽

A. Leppäniemi ◽

L. Handolin

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Organ Injury ◽

General Surgeon ◽

Emergency Laparotomy ◽

Trauma Patients ◽

Emergency Procedures ◽

Complex Skills

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

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