Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score‐adjusted untreated patients

2015 ◽  
Vol 78 (4) ◽  
pp. 721-728 ◽  
Author(s):  
Tatsuya Norii ◽  
Cameron Crandall ◽  
Yusuke Terasaka
Keyword(s):  
Propensity Score ◽  
Blunt Trauma ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Endovascular Balloon Occlusion

Trauma to the Abdomen and Pelvis

2018 ◽  
Author(s):  
Zahir Basrai ◽  
Timothy Jang ◽  
Manuel Celedon
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Peritoneal Lavage ◽  
Penetrating Trauma ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Abdominal Organs ◽  
Fast Exam ◽  
Definitive Management ◽  
Endovascular Balloon Occlusion

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs.   This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

scholarly journals Assessing the need for resuscitative endovascular balloon occlusion of the aorta (REBOA) for management of non-compressible hemorrhage at a Canadian urban trauma centre

2021 ◽  
Author(s):  
Elizabeth Purssell ◽  
Sean Patrick ◽  
Joseph Haegert ◽  
Vesna Ivkov ◽  
John Taylor
Keyword(s):  
Injury Severity ◽  
Retrospective Chart Review ◽  
Balloon Occlusion ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Potential Candidate ◽  
Study Objective ◽  
Resuscitative Thoracotomy ◽  
Less Invasive ◽  
Endovascular Balloon Occlusion

Abstract Introduction Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive alternative to resuscitative thoracotomy (RT) for life threatening, infra-diaphragmatic, non-compressible hemorrhage from trauma. Existing evidence surrounding the efficacy of REBOA is conflicting; nevertheless, expert consensus suggests that REBOA should be considered in select trauma patients. There has been a paucity of studies that evaluate the potential utility of REBOA in the Canadian setting. The study objective was to evaluate the percentage of trauma patients presenting to a Level 1 Canadian trauma centre that would have met criteria for REBOA. Methods We conducted a retrospective chart review of patients recorded in the British Columbia Trauma Registry who warranted a trauma team activation (TTA) at our institution. We identified REBOA candidates using pre-defined criteria based on published guidelines. Each TTA case was screened by a reviewer, and then each Potential Candidate was reviewed by a panel of trauma physicians for determination of final candidacy. Results Fourteen patients were classified as Likely REBOA Candidates (2.2% of TTAs, median age 46.1 years, 64.3% female). These patients had a median Injury Severity Score of 31.5 (IQR 26.8). The main sources of hemorrhage in these patients were from abdominal injuries (71.4%) and pelvic fractures (42.9%). Conclusion The percentage of patients who met criteria for REBOA is similar to that of RTs performed at our Canadian institution. While REBOA would be performed infrequently, it is a less-invasive alternative to RT, which could be a potentially life-saving procedure in a small group of the most severely injured trauma patients.

A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients

2018 ◽  
Vol 85 (3) ◽  
pp. 626-634 ◽  
Author(s):  
Ramiro Manzano-Nunez ◽  
Claudia P. Orlas ◽  
Juan P. Herrera-Escobar ◽  
Samuel Galvagno ◽  
Joseph DuBose ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Endovascular Balloon Occlusion

Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Trauma Patients with Pelvic Fracture

2020 ◽  
Vol 231 (4) ◽  
pp. S329-S330
Author(s):  
Samer Asmar ◽  
Muhammad Khurrum ◽  
Andrew Liang Tang ◽  
Letitia Bible ◽  
Narong Kulvatunyou ◽  
...  
Keyword(s):  
Pelvic Fracture ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Endovascular Balloon Occlusion

scholarly journals Resuscitative Endovascular Balloon Occlusion of the Aorta is a Risk Factor for Intestinal Necrosis: A Case Report

2020 ◽  
Author(s):  
Keitaro Yajima ◽  
Shokei Matsumoto ◽  
Motoyasu Yamazaki
Keyword(s):  
Case Reports ◽  
Severe Trauma ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Occlusion Time ◽  
Intestinal Necrosis ◽  
Ischemic Complications ◽  
Inappropriate Utilization ◽  
Enhanced Computed Tomography ◽  
Endovascular Balloon Occlusion

Abstract BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is effective for temporary hemorrhage control and resuscitative effort, as it enhances cerebral and coronary circulation in trauma patients. However, an inappropriate utilization of REBOA leads to critical complications. Placement of the balloon in Zone 2 of the aorta should be avoided as the occlusion restricts the intestinal blood supply leading to fatal complications. There is a scarcity of case reports on complications associated with endovascular balloon occlusion in the literature. Here, we have presented a rare case in which Zone 2 REBOA contributed to an ischemic complication in a trauma patient.Case presentationA 50-year-old man with severe trauma, who accidentally got buried under a fallen cement wall, was carried to the nearest hospital. Contrast-enhanced computed tomography showed an unstable pelvic fracture that required hemostatic intervention. Prior to being transferred to another hospital, the patient was treated with endovascular balloon placement. A Zone 2 endovascular balloon placement with resuscitative effort accidentally led to insufficient abdominal blood flow and he developed extensive intestinal necrosis. Following surgical intervention, the patient was resuscitated; however, he developed partial intestinal necrosis and was subsequently managed with surgical intestinal resection.ConclusionsBlood supply to the abdominal organs should be considered when deploying the balloon. Further, balloon positioning, aortic occlusion time, and inflation volume should be carefully considered to avoid ischemic complications.

scholarly journals Distal organ inflammation and injury after resuscitative endovascular balloon occlusion of the aorta in a porcine model of severe hemorrhagic shock

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242450
Author(s):  
Yansong Li ◽  
Michael A. Dubick ◽  
Zhangsheng Yang ◽  
Johnny L. Barr ◽  
Brandon J. Gremmer ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Positive Control ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Trauma Patients ◽  
Total Blood ◽  
Shed Blood ◽  
Endovascular Balloon Occlusion

Background and objective Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) has emerged as a potential life-saving maneuver for the management of non-compressible torso hemorrhage in trauma patients. Complete REBOA (cREBOA) is inherently associated with the burden of ischemia reperfusion injury (IRI) and organ dysfunction. However, the distal organ inflammation and its association with organ injury have been little investigated. This study was conducted to assess these adverse effects of cREBOA following massive hemorrhage in swine. Methods Spontaneously breathing and consciously sedated Sinclair pigs were subjected to exponential hemorrhage of 65% total blood volume over 60 minutes. Animals were randomized into 3 groups (n = 7): (1) Positive control (PC) received immediate transfusion of shed blood after hemorrhage, (2) 30min-cREBOA (A30) received Zone 1 cREBOA for 30 minutes, and (3) 60min-cREBOA (A60) given Zone 1 cREBOA for 60 minutes. The A30 and A60 groups were followed by resuscitation with shed blood post-cREBOA and observed for 4h. Metabolic and hemodynamic effects, coagulation parameters, inflammatory and end organ consequences were monitored and assessed. Results Compared with 30min-cREBOA, 60min-cREBOA resulted in (1) increased IL-6, TNF-α, and IL-1β in distal organs (kidney, jejunum, and liver) (p < 0.05) and decreased reduced glutathione in kidney and liver (p < 0.05), (2) leukopenia, neutropenia, and coagulopathy (p < 0.05), (3) blood pressure decline (p < 0.05), (4) metabolic acidosis and hyperkalemia (p < 0.05), and (5) histological injury of kidney and jejunum (p < 0.05) as well as higher levels of creatinine, AST, and ALT (p < 0.05). Conclusion 30min-cREBOA seems to be a feasible and effective adjunct in supporting central perfusion during severe hemorrhage. However, prolonged cREBOA (60min) adverse effects such as distal organ inflammation and injury must be taken into serious consideration.

3 Safely landing a resuscitative endovascular balloon occlusion of the aorta (REBOA) device in zone one

2018 ◽  
Vol 164 (3) ◽  
pp. 224.3-225
Author(s):  
O Jefferson ◽  
JJ Morrison
Keyword(s):  
Traumatic Injury ◽  
Emergency Situation ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Height Range ◽  
Fixed Distance ◽  
Significant Difference ◽  
Insertion Algorithm ◽  
Study Population ◽  
Endovascular Balloon Occlusion

BackgroundNon-compressible torso haemorrhage is a leading cause of potentially preventable death following trauma. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a technique to temporise haemorrhage. Areas for potential inflation have been characterised as zones I – III. Placement superior to zone I may cause harm. Fluoroscopy, used to confirm position, is often unavailable. The literature shows disagreement about whether a fixed insertion distance would be safe. Some papers advocate using a multi-variable insertion formula.MethodsThree cohorts of patients underwent retrospective analysis of their aortic morphometry. The patients had undergone CT imaging of their torsos when they presented to one of three centres following serious traumatic injury. Aortic reconstructions were performed and measurements taken. Virtual balloons were inserted to both fixed distances and distances calculated using previously reported formulae.ResultsThe study population consisted of trauma patients presenting to Camp Bastion, Afghanistan [n=177]; St Mary’s Hospital, London, UK [n=100]; Wilford Hall Hospital, Texas, US [n=88]. When compared, the 3 cohorts were sufficiently similar for combined analysis (n=365). The two fixed insertion distances (444 mm and 418 mm) each conveyed virtual balloon placement accuracies of 98.4% (359/365). The placements proximal to Zone I occurred in those patients with the smallest 2% of torso heights. The 2 formulae for calculating zone I insertion length each conveyed accuracy of 99.7% (364/365). Statistical analysis found no significant difference between formulaic and fixed insertion distance accuracies (p=0.07).ConclusionFixed distance insertion is more practical in an emergency situation; formulae conveyed no greater accuracy. Fixed distances may not suit a minority of patients who are in the extreme of a population’s height range. These findings support the trial of a zone I fixed distance insertion algorithm.

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