scholarly journals Introducing a New Concept of Fixed-Volume Aortic Occlusion for Fluoroscopy-Free Resuscitative Endovascular Balloon Occlusion of the Aorta

2021 ◽  
Vol 74 (5) ◽  
pp. e425
Author(s):  
Adam Power ◽  
Asha Parekh ◽  
Robert Leeper ◽  
Neil Parry ◽  
Laura J. Moore
Keyword(s):  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Fixed Volume ◽  
Endovascular Balloon Occlusion

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.

scholarly journals REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jostein Rødseth Brede ◽  
Arne Kristian Skulberg ◽  
Marius Rehn ◽  
Kjetil Thorsen ◽  
Pål Klepstad ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Multicentre Trial ◽  
Life Support ◽  
Intervention Group ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Adjunctive Treatment ◽  
Control Group ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Abstract Background Survival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports. Methods This multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 min. The secondary objectives of this trial are to measure the proportion of patients surviving to 30 days with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events. Discussion Results from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort. Trial registration The trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.

scholarly journals Loop formation by an aortic occlusion balloon catheter during resuscitative endovascular balloon occlusion of the aorta (REBOA)

2019 ◽  
Vol 14 (2) ◽  
pp. 184-186
Author(s):  
Yasuyuki Onishi ◽  
Hiroyuki Kimura ◽  
Mitsunori Kanagaki ◽  
Shojiro Oka ◽  
Genki Fukumoto ◽  
...  
Keyword(s):  
Balloon Catheter ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Loop Formation ◽  
Occlusion Balloon ◽  
Endovascular Balloon Occlusion ◽  
Occlusion Balloon Catheter

Assessment of Blood Flow Patterns Distal to Aortic Occlusion Using CT in Patients with Resuscitative Endovascular Balloon Occlusion of the Aorta

2018 ◽  
Vol 226 (3) ◽  
pp. 294-308 ◽  
Author(s):  
Philip J. Wasicek ◽  
Kathirkamanathan Shanmuganathan ◽  
William A. Teeter ◽  
William B. Gamble ◽  
Peter Hu ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Patterns ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Blood Flow Patterns ◽  
Endovascular Balloon Occlusion

Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Noncompressible Torso Hemorrhage

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Derek Jason Roberts ◽  
Bryan A. Cotton ◽  
Juan Duchesne ◽  
Paula Ferrada ◽  
Tal M. Horer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Circulatory Arrest ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Trauma Patients ◽  
Post Injury ◽  
Emergency Department Thoracotomy ◽  
Advantages And Disadvantages ◽  
Injured Patients ◽  
Endovascular Balloon Occlusion

Non-compressible torso haemorrhage (NCTH) (i.e., bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this manuscript, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude the above by providing recommendations as to when each of these methods may be best when indicated to manage injured patients with NCTH.

scholarly journals REBOARREST, resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest: a study protocol for a randomised, parallel group, clinical multicentre trial

2021 ◽  
Author(s):  
Jostein Rødseth Brede ◽  
Arne Kristian Skulberg ◽  
Marius Rehn ◽  
Kjetil Thorsen ◽  
Pål Klepstad ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Multicentre Trial ◽  
Life Support ◽  
Intervention Group ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Adjunctive Treatment ◽  
Control Group ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Abstract Background Survival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports. Methods This multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 minutes. The secondary objectives of this trial are to measure 30-day survival with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events. Discussion Results from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort. Trial registration The trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.

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