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.

914 A Comparison of Mortality, Indicators of Treatment Success and Complications of Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA): A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H J Ko ◽  
H F Koo ◽  
S Froghi ◽  
N Al-Saadi
Keyword(s):  
Hospital Mortality ◽  
Meta Analysis ◽  
Treatment Success ◽  
Estimation Method ◽  
Kidney Injury ◽  
Balloon Occlusion ◽  
Random Effects Model ◽  
Resuscitative Thoracotomy ◽  
Significant Difference ◽  
Endovascular Balloon Occlusion

Abstract Introduction This study aims to provide an updated review on in-hospital mortality rates in patients who underwent Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) versus Resuscitative thoracotomy (RT) or standard care without REBOA, to identify potential indicators of REBOA use and complications. Method Cochrane and PRISMA guidelines were used to perform the study. A literature search was done from 01 January 2005 to 30 June 2020 using EMBASE, MEDLINE and COCHRANE databases. Meta-analysis was conducted using a random effects model and the DerSimonian and Laird estimation method. Results 25 studies were included in this study. The odds of in-hospital mortality of patients who underwent REBOA compared to RT was 0.18 (p < 0.01). The odds of in-hospital survival of patients who underwent REBOA compared to non-REBOA was 1.28 (p = 0.62). There was a significant difference found between survivors and non-survivors in terms of their pre-REBOA systolic blood pressure (SBP) (19.26 mmHg, p < 0.01), post-REBOA SBP (20.73 mmHg, p < 0.01), duration of aortic occlusion (-40.57 mins, p < 0.01) and ISS (-8.50, p < 0.01). Common complications of REBOA included acute kidney injury, multi-organ dysfunction and thrombosis. Conclusions Our study demonstrated lower in-hospital mortality of REBOA versus RT. Prospective multi-centre studies are needed for further evaluation of the indications, feasibility, and complications of REBOA.

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 Fixed-Distance Model for Balloon Placement During Fluoroscopy-Free Resuscitative Endovascular Balloon Occlusion of the Aorta in a Civilian Population

JAMA Surgery ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. 351 ◽  
Author(s):  
Pierre Pezy ◽  
Alexandros N. Flaris ◽  
Nicolas J. Prat ◽  
François Cotton ◽  
Peter W. Lundberg ◽  
...  
Keyword(s):  
Balloon Occlusion ◽  
Civilian Population ◽  
Fixed Distance ◽  
Distance Model ◽  
Endovascular Balloon Occlusion

scholarly journals Location of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Zone III Using External Landmark Without Fluoroscopy: A CTA-based Retrospective Study

2020 ◽  
Author(s):  
Danlei Weng ◽  
Anyu Qian ◽  
Qijing Zhou ◽  
Jiefeng Xu ◽  
Shanxiang Xu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Average Length ◽  
Safety Margin ◽  
Balloon Occlusion ◽  
University Hospital ◽  
Xiphoid Process ◽  
Significant Difference ◽  
The Right ◽  
External Landmark ◽  
Endovascular Balloon Occlusion

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) can timely prevent the wounded from massive hemorrhage. We aim to study whether the combination of the xiphoid process and the umbilicus could guide the placement of REBOA in zone III without fluoroscopy. Methods We conducted a retrospective study in a university hospital that included 57 subjects who underwent contrast-enhanced computed tomography (CT) from April to December in 2019. External distances and intravascular lengths were measured by three-dimensional reconstruction CT images on the workstation, including the distances from the femoral artery to the xiphoid process (FA-Xi), the midpoint between the xiphoid process and the umbilicus (FA-mXU), the umbilicus (FA-Ui), the midpoint of the zone III (FA-mZIII), the lowest renal artery (FA-LRA), and aortic bifurcation (FA-AB). The relationship between external landmarks and REBOA catheter positioning in zone III was studied, involving the quartering distances between the xiphoid process and the umbilicus, the distance below the xiphoid process and that above the umbilicus. The predicted accuracy and safety margin of the balloon (distal and proximal) were calculated by curvature plane reconstruction. The probability of balloon positioning in zone III using these three methods was compared by Chi square test. Results The average length of aortic zone III was 9.4 cm (SD = 10.0), and that of FA-mZIII on the right and left sides were 24.4 cm (SD = 2.1) ,23.8 cm (SD = 2.1), respectively. FA-Xi was significantly longer than FA-LRA, and FA-Ui was significantly shorter than FA-AB (P < 0.05). Using the quartering distances between the xiphoid and the umbilicus, the distance below the xiphoid, the distance above the umbilicus to predict the length of REBOA catheter positioning in zone III showed no statistically significant difference. Using FA-mXU to predict the accuracy of catheter positioning in zone III on the left and right sides were 84.2% and 86%. Although there was a little difference between the left side of FA-mZIII and FA-mXU, there were no statistical differences on the right side. Conclusions The midpoint between the xiphoid process and the umbilicus is a good external landmark to guide the placement of REBOA in zone III without fluoroscopy.

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