Abdominal aortic and junctional tourniquet versus zone III resuscitative endovascular balloon occlusion of the aorta in a swine junctional hemorrhage model

2020 ◽  
Vol 88 (2) ◽  
pp. 292-297
Author(s):  
David W. Schechtman ◽  
David S. Kauvar ◽  
Rodolfo De Guzman ◽  
I. Amy Polykratis ◽  
M. Dale Prince ◽  
...  
Keyword(s):  
Balloon Occlusion ◽  
Abdominal Aortic ◽  
Endovascular Balloon Occlusion

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Valentina Chiarini
Keyword(s):  
Trauma Center ◽  
Aortic Rupture ◽  
Damage Control ◽  
Aortic Injury ◽  
Balloon Occlusion ◽  
Traumatic Lesion ◽  
Abdominal Aortic ◽  
Aortic Injuries ◽  
Accepted Practice ◽  
Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

scholarly journals 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

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.

The Use of Rapid Endovascular Balloon Occlusion in Unstable Patients with Ruptured Abdominal Aortic Aneurysm

2009 ◽  
Vol 4 (2) ◽  
pp. 74-79 ◽  
Author(s):  
Tine E. Philipsen ◽  
Jeroen M. Hendriks ◽  
Patrick Lauwers ◽  
Maurits Voormolen ◽  
Olivier d'Archambeau ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Balloon Occlusion ◽  
Open Group ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic ◽  
Valuable Treatment ◽  
Endovascular Balloon Occlusion ◽  
Tomography Scan

Objective To present our results and demonstrate advantages of rapid endovascular balloon occlusion (REBO) of the juxtarenal aorta in unstable patients with ruptured abdominal aortic aneurysm (rAAA). Methods Since 2006, all unstable patients with rAAA are immediately transferred to the operating room (OR). No computed tomography scan is performed once diagnosis is made on ultrasound examination. Instability is defined as systolic blood pressure less than 60 mm Hg, unconsciousness, cardiac ischemia, or intubation. Once arrived in the OR, a Reliant aortic balloon is introduced and inflated at the level of the renal arteries. Subsequently, an angiogram is made through the contralateral femoral artery in order to decide between open or endovascular repair (EVAR). Results Twelve patients with rAAA were defined as unstable. REBO was installed within 10 minutes after arrival in the OR. Aortic occlusion resulted in immediate hemodynamic stability. Five patients were suitable for EVAR. Seven patients had open repair. For these abdominal dissection was more careful since no instability was encountered. All patients survived the procedure except one. Mean stay on intensive care unit was 19.7 days for open group and 8.4 for EVAR. Conclusions REBO of the juxtarenal abdominal aorta by pc technique in unstable patients with rAAA resulted in a 17% 30-day mortality and a 100% 1-year event-free follow-up for survivors. With this technique, EVAR exclusion is still a valuable treatment. Exposure and decision making for the open group is easier to perform with less risk for additional damaging to neighboring structures during dissection since urgent cross-clamping is not necessary.

Partial Aortic Occlusion using Resuscitative Endovascular Balloon Occlusion of the Aorta (P-REBOA) in Ruptured Abdominal Aortic Aneurysm

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Fareed Cheema ◽  
Aksim Rivera ◽  
Amit Shah ◽  
Sheldon Teperman ◽  
Melvin E. Stone ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Hemorrhagic Shock ◽  
Balloon Occlusion ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Cardiovascular Collapse ◽  
Abdominal Aortic ◽  
Blood Pressure Goals ◽  
Endovascular Balloon Occlusion

Ruptured abdominal aortic aneurysm is often a fatal event without immediate intervention for the associated hemorrhagic shock and impending cardiovascular collapse. We report a case of a ruptured abdominal aortic aneurysm managed with partially occlusive resuscitative endovascular balloon occlusion of the aorta (P-REBOA) as a means to gain proximal control, tailor blood pressure goals, while allowing time to obtain access and repair the ruptured aneurysm.

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