Do we need a upper systolic blood pressure limit to prevent aortic rupture in complete resuscitative endovascular balloon occlusion of the aorta?

Resuscitative endovascular balloon occlusion of the aorta (REBOA) represents an innovative method by which noncompressible bleeding in the torso can be mitigated until definitive treatment can be obtained. To perform a systematic review of the literature on the use of the REBOA in trauma patients. An English and Spanish literature search was performed using MEDLINE, PubMed, and Scopus, from 1948 to 2018. Keywords used were aortic balloon occlusion, resuscitative endovascular balloon, REBOA, hemorrhage, and resuscitative endovascular balloon occlusion of the aorta. The eligilibility criteria included only original and human subject articles. Nontrauma patients, nonbleeding pathology, letters, single case reports, reviews, and pediatric patients were excluded. Two hundred forty-six articles were identified, of which 17 articles were included in this review. The total number of patients was 1340; 69 per cent were men and 31 per cent women. In 465 patients, the aortic zone location was described: 83 per cent the balloon was placed in aortic zone I and 16 per cent in zone III. Systolic blood pressure increased at an average of 52 mmHg before and after aortic occlusion. Although 32 patients (2.4%) presented clinical complications derived from the procedure, no mortality was reported. The trauma-related mortality rate was 58 per cent (776/1340). REBOA is a useful resource for the management of non-compressive torso hemorrhage with promising results in systolic blood pressure and morbidity. Indications for its use include injuries in zones 1 and 3, whereas it is not clear for zone 2 injuries. Additional studies are needed to define the benefits of this procedure.

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Implementation of resuscitative endovascular balloon occlusion of the aorta at the Korean Regional Trauma Center

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919866563 ◽

2019 ◽

pp. 102490791986656 ◽

Cited By ~ 1

Author(s):

Youngeun Park ◽

Byungchul Yu ◽

Giljae Lee ◽

Jungnam Lee ◽

Kangkook Choi ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Trauma Center ◽

Implementation Process ◽

Balloon Occlusion ◽

Brief Training ◽

Training Courses ◽

Trauma Surgeons ◽

Trauma Bay ◽

Endovascular Balloon Occlusion

Background: Resuscitative endovascular balloon occlusion of the aorta is used as adjunctive management for a profound shock in some trauma centers. We report our early experience of resuscitative endovascular balloon occlusion of the aorta to describe the implementation and possible indications of resuscitative endovascular balloon occlusion of the aorta. Objective: This study was designed to investigate the feasibility and effectiveness of resuscitative endovascular balloon occlusion of the aorta based on our experience and share our implementation process by trauma surgeons in Korea. Methods: We performed a retrospective review of consecutive cases of resuscitative endovascular balloon occlusion of the aorta in profound shock due to noncompressible torso hemorrhage at a single Korean trauma center. Resuscitative endovascular balloon occlusion of the aorta was introduced and implemented with written protocol and endovascular training courses. Results: All cases ( n = 24) were done for blunt mechanisms. Twelve cases (50%) were resuscitative endovascular balloon occlusion of the aorta in zone I, three cases (12.5%) were zone II, and nine cases (45%) in zone III. Mean pre-occlusion systolic blood pressure was 47 mm Hg and mean systolic blood pressure increase was 41.3 mm Hg. Twenty-one patients (87.5%) survived at trauma bay and seven patients (29.2%) survived and discharged without neurologic deficit. There were two complications directly related to the procedure. Conclusion: Resuscitative endovascular balloon occlusion of the aorta is a useful adjunctive skill for trauma surgeons, and a brief training course can help in the implementation of the procedure.

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

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i1.74 ◽

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.

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Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01586-9 ◽

2021 ◽

Author(s):

David T. McGreevy ◽

Mitra Sadeghi ◽

Kristofer F. Nilsson ◽

Tal M. Hörer

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Hemodynamic Instability ◽

Balloon Occlusion ◽

University Hospital ◽

Trauma Patients ◽

Single Center ◽

Hemorrhage Control ◽

Single Center Experience ◽

Low Profile

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

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Distal Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to Restore Hemodynamic Stability in a Patient With Proximal Aortic Rupture

Journal of Endovascular Therapy ◽

10.1177/1526602818757012 ◽

2018 ◽

Vol 25 (2) ◽

pp. 257-260 ◽

Cited By ~ 1

Author(s):

Shira Strauss ◽

Paul Engels ◽

John Harlock

Keyword(s):

Aortic Rupture ◽

Balloon Occlusion ◽

Hemodynamic Stability ◽

Endovascular Balloon Occlusion

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Traumatic cardiac arrest and resuscitative endovascular balloon occlusion of the aorta (REBOA): a preliminary analysis utilizing high fidelity invasive blood pressure recording and videography

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-018-0989-5 ◽

2018 ◽

Vol 45 (6) ◽

pp. 1097-1105 ◽

Cited By ~ 5

Author(s):

Philip J. Wasicek ◽

Shiming Yang ◽

William A. Teeter ◽

Peter Hu ◽

Deborah M. Stein ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Preliminary Analysis ◽

Balloon Occlusion ◽

High Fidelity ◽

Invasive Blood Pressure ◽

Pressure Recording ◽

Traumatic Cardiac Arrest ◽

Endovascular Balloon Occlusion ◽

Blood Pressure Recording

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Controversial US guidelines raise systolic blood pressure limit for healthy over 60s

BMJ ◽

10.1136/bmj.j332 ◽

2017 ◽

pp. j332

Author(s):

Michael McCarthy

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Pressure Limit

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

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i2.87 ◽

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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