Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage

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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Increased crystalloid fluid requirements during zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) versus Abdominal Aortic and Junctional Tourniquet (AAJT) after class II hemorrhage in swine

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01592-x ◽

2021 ◽

Author(s):

Andreas Brännström ◽

Albin Dahlquist ◽

Jenny Gustavsson ◽

Ulf P. Arborelius ◽

Mattias Günther

Keyword(s):

Fluid Management ◽

Class Ii ◽

Balloon Occlusion ◽

Metabolic Effects ◽

Total Blood ◽

Crystalloid Fluid ◽

Vasopressor Support ◽

Abdominal Aortic ◽

Life Threatening ◽

Endovascular Balloon Occlusion

Abstract Purpose Pelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer’s acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg. Methods 60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion. Results Cumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support. Conclusion Zone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support.

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Trauma to the Abdomen and Pelvis

10.2310/tywc.4353 ◽

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

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A successful hybrid operation for life-threatening hemorrhagic shock secondary to an iatrogenic ruptured pseudoaneurysm of the external iliac artery following percutaneous arterial access

Emergency Care Journal ◽

10.4081/ecj.2018.7541 ◽

2018 ◽

Vol 14 (3) ◽

Author(s):

Takahiro Shoji ◽

Hirohisa Harada ◽

Shinji Yamazoe ◽

Yoshihiro Yamaguchi

Keyword(s):

Renal Artery ◽

Iliac Artery ◽

Arterial Embolization ◽

External Iliac Artery ◽

Vascular Trauma ◽

Balloon Occlusion ◽

Arterial Access ◽

Iatrogenic Complications ◽

Life Threatening ◽

Endovascular Balloon Occlusion

Intravascular treatments such as arterial embolization and resuscitative endovascular balloon occlusion of the aorta are being increasingly performed in emergency cases, in addition to the increasing use of arterial access as an intensive care monitoring tool. Thus, arterial access-related complications are being commonly reported. A 40- year-old man with renal artery stenosis underwent renal artery stent placement via the left inguinal puncture approach. After the procedure, his groin was manually compressed to hemostasis for 30 min. He unexpectedly developed shock the following day, and computed tomography revealed a ruptured pseudoaneurysm of the left external iliac artery (EIA) following iatrogenic vascular trauma owing to an inappropriately performed groin puncture. We initially controlled the hemorrhage using endovascular balloon occlusion of the left EIA. Subsequently, the injured EIA was repaired using a direct suture. The postoperative course was uneventful. Herein, we evaluated the causes of iatrogenic complications and the effectiveness of our treatment strategy.

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

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000000578 ◽

2015 ◽

Vol 78 (4) ◽

pp. 721-728 ◽

Cited By ~ 111

Author(s):

Tatsuya Norii ◽

Cameron Crandall ◽

Yusuke Terasaka

Keyword(s):

Propensity Score ◽

Blunt Trauma ◽

Balloon Occlusion ◽

Trauma Patients ◽

Endovascular Balloon Occlusion

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Trauma to the Abdomen and Pelvis

10.2310/em.4353 ◽

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

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Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

PLoS ONE ◽

10.1371/journal.pone.0174520 ◽

2017 ◽

Vol 12 (3) ◽

pp. e0174520 ◽

Cited By ~ 23

Author(s):

Knut Haakon Stensaeth ◽

Edmund Sovik ◽

Ingrid Natasha Ylva Haig ◽

Erna Skomedal ◽

Arve Jorgensen

Keyword(s):

Postpartum Hemorrhage ◽

Balloon Occlusion ◽

Life Threatening ◽

Endovascular Balloon Occlusion

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The usefulness of resuscitative endovascular balloon occlusion of the aorta in detecting the source of a hemorrhage due to abdominal blunt trauma

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2016.03.026 ◽

2016 ◽

Vol 34 (10) ◽

pp. 2057.e1-2057.e3 ◽

Cited By ~ 3

Author(s):

Naoya Matsumoto ◽

Osanori Sogabe ◽

Osamu Yoshida ◽

Izuru Endo ◽

Sumiharu Yamamoto ◽

...

Keyword(s):

Blunt Trauma ◽

Balloon Occlusion ◽

Abdominal Blunt Trauma ◽

Endovascular Balloon Occlusion

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Intra-aortic balloon occlusion without fluoroscopy for life-threating post-partum hemorrhage

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2015-0050 ◽

2016 ◽

Vol 5 (1) ◽

pp. 19-22

Author(s):

Yuka Yamashita ◽

Akihiro Kawashima ◽

Junichi Hasegawa ◽

Tomohiro Oba ◽

Masamitsu Nakamura ◽

...

Keyword(s):

Cesarean Section ◽

Postpartum Hemorrhage ◽

Post Partum ◽

Balloon Occlusion ◽

Post Partum Hemorrhage ◽

Radical Treatment ◽

Aortic Balloon Occlusion ◽

Life Threatening ◽

Endovascular Balloon Occlusion

Abstract The use of intra-aortic balloon occlusion (IABO) could be effective in achieving the quick control of bleeding in emergency settings and in supporting the provision of safe radical treatment through resuscitative endovascular balloon occlusion of the aorta (REBOA). We herein report our experience of a patient with life-threatening postpartum hemorrhage after cesarean section who was successfully treated by hysterectomy with IABO without fluoroscopy. We believe that this procedure is very useful and safe, and that it should be considered as one of methods for controlling bleeding in patients with life-threatening postpartum hemorrhage.

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Case Report: Lifesaving Hemostasis With Resuscitative Endovascular Balloon Occlusion of the Aorta in a Patient With Cardiac Arrest Caused by Upper Gastrointestinal Hemorrhage

Frontiers in Medicine ◽

10.3389/fmed.2021.777421 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tomoaki Hashida ◽

Nanami Hata ◽

Akiko Higashi ◽

Yoshito Oka ◽

Shunsuke Otani ◽

...

Keyword(s):

Cardiac Arrest ◽

Hemorrhagic Shock ◽

Gastrointestinal Hemorrhage ◽

Balloon Occlusion ◽

Upper Gastrointestinal Hemorrhage ◽

Mild Anemia ◽

Life Threatening ◽

History Of ◽

Upper Gastrointestinal ◽

Endovascular Balloon Occlusion

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed to treat hemorrhagic shock, whose cause is located below the diaphragm. However, its use in patients with gastrointestinal hemorrhage is relatively rare. The 45-year-old man with a history of dilated cardiomyopathy had experienced epigastric discomfort and had an episode of presyncope. On his presentation, the patient's blood pressure was 82/64 mmHg, heart rate 140/min, and consciousness level GCS E4V5M6. Hemodynamics stabilized rapidly with a transfusion that was administered on an emergency basis, and a blood sample only showed mild anemia (Hb, 11.5 g/dL). The patient was admitted to investigating the presyncope episode, and the planned endoscopy was scheduled the following day. The patient had an episode of presyncope soon and was found in hemorrhagic shock resulting from a duodenal ulcer rapidly deteriorated to cardiac arrest. Although a spontaneous heartbeat was restored with cardiopulmonary resuscitation, the patient's hemodynamics were unstable despite the emergency blood transfusion administered by pumping. Consequently, a REBOA device was placed, resuscitation was continued, and hemostasis was achieved by vascular embolization for the gastroduodenal artery. The patient was subsequently discharged without complications. However, there is no established evidence regarding the REBOA use in upper gastrointestinal hemorrhage, and the investigations that have been reported have been limited. Further, one recent research suggests that appropriate patient selection and early use may improve survival in these life-threatening cases. As was seen in the present case, REBOA can effectively treat upper gastrointestinal hemorrhage by temporarily stabilizing hemodynamics and enabling a hemostatic procedure to be quickly performed during that time. This report also demonstrated the hemodynamics during the combination of intermittent and partial REBOA to avoid the complications of ischemic or reperfusion injury of the intestines or lower extremities.

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