Abstract 16745: It Would be Possible to Rescue Traumatic Hemorrhagic Shock Patients Who Failed to Fluid Resuscitation (Fluid Non-responder) but Succeed in REBOA Resuscitation (REBOA/IABO Responder)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tomohiko Orita ◽  
Tomohiro Funabiki ◽  
Motoyasu Yamazaki ◽  
Masayuki Shimizu ◽  
Tomohiro Sato ◽  
...  
Keyword(s):  
Survival Rate ◽  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Recovery Rate ◽  
Balloon Occlusion ◽  
Shock State ◽  
Occlusion Time ◽  
Aortic Balloon Occlusion ◽  
Significant Difference ◽  
Traumatic Hemorrhagic Shock

Introduction: Fluid resuscitation (FR) and massive transfusion protocol (MTP) are important initial strategies for traumatic hemorrhagic shock cases. But poor responded patients to them are difficult to rescue. In such cases, open aortic cross clamping or intra-aortic balloon occlusion (IABO) would be performed as a temporary hemostasis treatment. Recently, IABO for severe trauma has been named resuscitative endovascular balloon occlusion of the aorta (REBOA). But it is still unclear which case can be rescued with REBOA. So we studied the relationship between the responsiveness to FR and REBOA. Methods: Consecutive 46 traumatic hemorrhagic shock patients underwent REBOA at our ER for last 86 months were included. All of their FAST were positive and done FR and MTP as a first-line resuscitation. 10Fr or 7Fr IABO devices were inserted at supraphrenic level (zone I) and underwent fundamental hemostasis by operative management (OM) and/or transcatheter arterial embolization (TAE). They were sorted into responded group or non-responded group for REBOA. The primary end point was a recovery rate from the shock state within 48 hours. Secondary end points were a survival rate in 30th days and a rate of complications. Results: 26 transient or non-responded patients (Fluid Non-responder) responded for REBOA (REBOA Responder group). 20 Fluid Non-responders did not respond for REBOA (REBOA Non-responder group). There were no significant differences in ISS (REBOA Responder vs. Non-responder: 45.8+/-15.2 vs. 54.8+/-22.3), amount of total fluid (7187+/-5782ml vs. 6772+/-4851) and total blood transfusion (4816+/-3006ml vs. 5080+/-3330), required time to occlude after arriving ER (25.3+/-12.6min vs. 19.4+/-9.8) and total occlusion time (76.4+/-66.5min vs. 92.7+/-34.4). There was significant difference in the changes of systolic blood pressure before and after of REBOA (59.3+/-25.7mmHg vs. 38.3+/-39.4, p=0.04). A recovery rate from shock state was 65%(12/26) vs. 0%(0/20) (p<0.01) and a survival rate was 14/26(54%) vs. 0/20(0%) (p<0.01). One complication occurred in REBOA Responder group but was not lethal. Conclusions: It would be necessary to recognize that Fluid Non-responder but REBOA Responder with traumatic hemorrhagic shock could be possible to rescue.

Abstract 190: Hybrid Strategy of Damage Control IR (DCIR) and REBOA Would be Feasible for Traumatic Hemorrhagic Shock Patients Suffering From Severe Pelvic Injuries

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Tomohiko Orita ◽  
Shokei Matsumoto ◽  
Tomohiro Funabiki ◽  
Masayuki Shimizu ◽  
Yukitoshi Toyoda ◽  
...  
Keyword(s):  
Survival Rate ◽  
Blood Transfusion ◽  
Hemorrhagic Shock ◽  
Pelvic Fracture ◽  
Damage Control ◽  
Severe Trauma ◽  
Shock State ◽  
Hybrid Strategy ◽  
Crystalloid Infusion ◽  
Traumatic Hemorrhagic Shock

Introduction: Massive hemorrhage with pelvic injury is sometimes lethal. So, success or failure of hemostatic intervention in the hyperacute phase leads to survival of patients directly. Recently, a hybrid strategy with Operative Management (OM) and Interventional Radiology (IR) and/or Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for torso or pelvic severe trauma has been recognized world-widely. But, awareness of Damage control IR (DCIR) which is conscious of time and coagulopathy as Damage control surgery (DCS) is still not enough. So, we studied the possibility of the hybrid strategy with DCIR and REBOA for traumatic hemorrhagic shock patients with pelvic fracture. Methods: This study included patients who underwent traditional IR or DCIR with REBOA, if it were needed, for a traumatic shock state mainly due to pelvic fracture, at our emergency and trauma center. They were sorted into traditional IR group (group IR) and DCIR group (group DCIR). The primary endpoint was a survival rate in the first 30 days after injured. Secondary endpoints were fluid factors such as total amount of crystalloid infusion and blood transfusion within the first 24 hours, and for the duration of the recovery from shock state. Results: 64 trauma shock patients were sorted into group IR (n=38) and group DCIR (n=26). All REBOA patients (n=18) were in group DCIR. Initial systolic BP (group IR vs DCIR; 75mmHg vs. 54), RTS (5.66 vs. 4.12) and Ps (0.61 vs. 0.39) were significantly lower in group DCIR. ISS (32.8 vs. 41.5) and initial Shock Index (1.9 vs. 2.4) were higher in group DCIR significantly. There were no significant differences in the amount of total crystalloid infusion (7353+/-3152ml vs. 7140+/-5342ml) and blood transfusion (4183+/-3485ml vs. 3972+/-3188ml), and the survival rate (30/38 (79%) vs. 16/28 (62%)). But the required time to recovery from shock state was significantly shorter in group DCIR (65min vs. 43min). Conclusion: The hybrid strategy with DCIR and REBOA did not increase any amount of blood transfusion or crystalloid infusion or the mortality rate. But it could shorten the duration of shock state compared with traditional IR treatment. Thus, this hybrid strategy would be feasible for hemorrhage shock patients suffering from pelvic severe trauma.

Temporary Percutaneous Aortic Balloon Occlusion to Enhance Fluid Resuscitation Prior to Definitive Embolization of Post-Traumatic Liver Hemorrhage

2001 ◽  
Vol 24 (4) ◽  
pp. 274-276 ◽  
Author(s):  
Shin Matsuoka ◽  
Katsuhiro Uchiyama ◽  
Hideki Shima ◽  
Sonomi Ohishi ◽  
Yoko Nojiri ◽  
...  
Keyword(s):  
Fluid Resuscitation ◽  
Balloon Occlusion ◽  
Aortic Balloon Occlusion ◽  
Post Traumatic

The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock

2014 ◽  
Vol 191 (2) ◽  
pp. 423-431 ◽  
Author(s):  
Jonathan J. Morrison ◽  
James D. Ross ◽  
Nickolay P. Markov ◽  
Daniel J. Scott ◽  
Jerry R. Spencer ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Balloon Occlusion ◽  
Aortic Balloon Occlusion

scholarly journals Early Outcomes of Three Total Arch Replacement Strategies for DeBakey Type I Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Enzehua Xie ◽  
Jinlin Wu ◽  
Juntao Qiu ◽  
Lu Dai ◽  
Jiawei Qiu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Techniques ◽  
Operation Time ◽  
Balloon Occlusion ◽  
Total Arch Replacement ◽  
Type I ◽  
Elephant Trunk ◽  
Aortic Cross Clamp Time ◽  
Aortic Balloon Occlusion ◽  
Significant Difference

Background: This study employed three surgical techniques: total arch replacement (TAR) with frozen elephant trunk (FET), aortic balloon occlusion technique (ABO) and hybrid aortic arch repair (HAR) on patients with type I aortic dissection in Fuwai Hospital, aiming to compare the early outcomes of these surgical armamentariums.Methods: From January 2016 to December 2018, an overall 633 patients (431 of TAR+FET, 122 of HAR, and 80 of ABO) with type I aortic dissection were included in the study. Thirty-day mortality, stroke, paraplegia, re-exploration for bleeding, and renal replacement therapy were compared using the matching weight method (MWM).Results: After MWM process, the baseline characteristics were comparable among three TAR groups. It showed that ABO group had the longest cardiopulmonary bypass (p &lt; 0.001) and aortic cross-clamp time (p &lt; 0.001), while the operation time was longest in the HAR group (p = 0.039). There was no significant difference in 30-day mortality among groups (p = 0.783). Furthermore, the incidence of stroke (p = 0.679), paraplegia (p = 0.104), re-exploration for bleeding (p = 0.313), and CRRT (p = 0.834) demonstrated no significant difference. Of note, no significant differences were found regarding these outcomes even before using MWM.Conclusions: Based on the early outcomes, the three TAR approaches were equally applicable to type I aortic dissection. We may choose the specific procedure relatively flexibly according to patient status and surgeon's expertise. Importantly, long-term investigations are warranted to determine whether above approaches remain to be of equivalent efficacy and safety.

Abstract 1807: Low-volume Resuscitation From Traumatic Hemorrhagic Shock With Na+/H+ Exchanger Inhibitor

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Dongmei Wu ◽  
Hui Dai ◽  
Jaqueline Arias ◽  
Loren Latta
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Soft Tissue Injury ◽  
Hemodynamic Response ◽  
Fluid Replacement ◽  
Male Rats ◽  
List Type ◽  
Volume Resuscitation ◽  
Low Volume ◽  
Traumatic Hemorrhagic Shock

Background: Severe hemorrhage from traumatic injury is a major causative factor in almost half of these deaths on the battlefield, especially during the early period (<2h) after injury. Intervention with low-volume fluid resuscitation is increasingly preferred than more aggressive fluid replacement. We evaluated the use of a Na+/H+ exchanger (NHE) inhibitor, as a cardioprotective adjunct therapy to low-volume resuscitation in a rat model of traumatic hemorrhagic shock. Methods: Femur fracture with soft tissue injury was induced in 28 anesthetized male rats. The animals were then bled via the carotid artery to maintain a mean arterial pressure of 40 mmHg for 20 minutes. Groups: no therapy; 15 ml/kg Hextend infusion over 40 minutes; 3 mg/kg BIIB513 (NHE-1 inhibitor) + 15 ml/kg Hextend infusion over 40 minutes. After 4 hours, the animals who survived received a second infusion of Hextend. The experiment was terminated at 6 hours after initial resuscitation. Data are reported as mean ± SD. Results: All animals in the no therapy group died within 2 hours. Compared to Hextend infusion alone, the addition of NHE-1 inhibition with BIIB513, improved the hemodynamic response to fluid resuscitation (Fig 1 ), increased blood oxygen content, prevented metabolic acidosis, and improved 6 hour survival (42% in Hextend group vs 80% in BIIB513 + Hextend group). NHE-1 inhibition also resulted in reduced plasma levels of TNF-α, ICAM-1 and C-reactive protein, and attenuated neutrophil infiltration in the liver. Conclusion : NHE-1 inhibition with BIIB513 improved the hemodynamic response to fluid resuscitation, attenuated tissue inflammatory mediators, and most importantly improved survival.

Physiologic Tolerance of Descending Thoracic Aortic Balloon Occlusion in a Swine Model of Hemorrhagic Shock

2012 ◽  
Vol 172 (2) ◽  
pp. 324
Author(s):  
N.P. Markov ◽  
T. Percival ◽  
S. Patel ◽  
D.J. Scott ◽  
J.R. Spencer ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Balloon Occlusion ◽  
Swine Model ◽  
Aortic Balloon Occlusion

scholarly journals Combined, Converted, and Prophylactic Use of Resuscitative Endovascular Balloon Occlusion of the Aorta for Severe Torso Trauma: A Retrospective Study

2021 ◽  
Author(s):  
Takayuki Irahara ◽  
Dai Oishi ◽  
Masanobu Tsuda ◽  
Yuka Kajita ◽  
Hisatake Mori ◽  
...  
Keyword(s):  
Cardiopulmonary Arrest ◽  
Survival Rates ◽  
Balloon Occlusion ◽  
Shock Group ◽  
Total Occlusion ◽  
Occlusion Time ◽  
Resuscitative Thoracotomy ◽  
Aortic Balloon Occlusion ◽  
Torso Trauma ◽  
Endovascular Balloon Occlusion

Abstract Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used as an intra-aortic balloon occlusion method in Japan; however, the protocols for its effective use in different pathological conditions remain unclear. This study aimed to summarise the strategies of REBOA use in severe torso trauma.Methods: Twenty-nine cases of REBOA for torso trauma treated at our hospital over 5 years were divided into the shock (n=12), cardiopulmonary arrest (CPA) (n=13), and non-shock (n=4) groups. We retrospectively examined patient characteristics, trauma mechanism, injury site, severity score, intervention, survival rates at 24 hours, and intervention details in each group.Results: In the shock group, 9 and 3 patients survived and died within 24 hours, respectively; time to intervention (56.6 vs 130.7 min, p=0.346) and total occlusion time (40.2 vs 337.7 min, p=0.009) were both shorter in surviving patients than in the casualties. In the CPA group, 10 patients were converted from resuscitative thoracotomy with aortic cross-clamp (RTACC); a single patient survived. Four patients in the non-shock group survived, having received prophylactic REBOA.Conclusions: The efficacy of REBOA for severe torso trauma depends on patient condition. In the shock group, time to intervention and total occlusion time correlated with survival. The use of REBOA with definitive haemostasis and minimum delays to intervention may improve outcomes. Patients with CPA are at a high risk of mortality; however, conversion from RTACC may be effective in some cases. Prophylactic intervention in the non-shock group may help achieve immediate definitive haemostasis.

Intra-aortic balloon occlusion catheter for treating hemorrhagic shock after massive duodenal ulcer bleeding

2015 ◽  
Vol 33 (3) ◽  
pp. 473.e1-473.e2 ◽  
Author(s):  
Shintaro Shigesato ◽  
Tetsunosuke Shimizu ◽  
Tadahiro Kittaka ◽  
Hiroshi Akimoto
Keyword(s):  
Duodenal Ulcer ◽  
Hemorrhagic Shock ◽  
Balloon Occlusion ◽  
Ulcer Bleeding ◽  
Aortic Balloon Occlusion
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