Hemodynamic Effect of Resuscitative Endovascular Balloon Occlusion Of The Aorta In Hemodynamic Instability Secondary To Acute Cardiac Tamponade In A Porcine Model

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.

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

Patient Safety in Surgery ◽

10.1186/s13037-019-0223-3 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 3

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.

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Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock

Surgery ◽

10.1016/j.surg.2011.06.010 ◽

2011 ◽

Vol 150 (3) ◽

pp. 400-409 ◽

Cited By ~ 152

Author(s):

Joseph M. White ◽

Jeremy W. Cannon ◽

Adam Stannard ◽

Nickolay P. Markov ◽

Jerry R. Spencer ◽

...

Keyword(s):

Hemorrhagic Shock ◽

Porcine Model ◽

Balloon Occlusion ◽

Resuscitative Thoracotomy ◽

Aortic Clamping ◽

Endovascular Balloon Occlusion

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

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-018-0983-y ◽

2018 ◽

Vol 44 (4) ◽

pp. 487-489 ◽

Cited By ~ 6

Author(s):

Tal Hörer

Keyword(s):

Paradigm Shift ◽

Hemodynamic Instability ◽

Balloon Occlusion ◽

Trauma Management ◽

Endovascular Balloon Occlusion

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

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i3.92 ◽

2019 ◽

Vol 3 (3) ◽

Cited By ~ 1

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.

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