Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Management of Trauma Patients: A Systematic Literature Review

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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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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Resuscitative Endovascular Balloon Occlusion of the Aorta is a Risk Factor for Intestinal Necrosis: A Case Report

10.21203/rs.3.rs-102623/v1 ◽

2020 ◽

Author(s):

Keitaro Yajima ◽

Shokei Matsumoto ◽

Motoyasu Yamazaki

Keyword(s):

Case Reports ◽

Severe Trauma ◽

Balloon Occlusion ◽

Trauma Patients ◽

Occlusion Time ◽

Intestinal Necrosis ◽

Ischemic Complications ◽

Inappropriate Utilization ◽

Enhanced Computed Tomography ◽

Endovascular Balloon Occlusion

Abstract BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is effective for temporary hemorrhage control and resuscitative effort, as it enhances cerebral and coronary circulation in trauma patients. However, an inappropriate utilization of REBOA leads to critical complications. Placement of the balloon in Zone 2 of the aorta should be avoided as the occlusion restricts the intestinal blood supply leading to fatal complications. There is a scarcity of case reports on complications associated with endovascular balloon occlusion in the literature. Here, we have presented a rare case in which Zone 2 REBOA contributed to an ischemic complication in a trauma patient.Case presentationA 50-year-old man with severe trauma, who accidentally got buried under a fallen cement wall, was carried to the nearest hospital. Contrast-enhanced computed tomography showed an unstable pelvic fracture that required hemostatic intervention. Prior to being transferred to another hospital, the patient was treated with endovascular balloon placement. A Zone 2 endovascular balloon placement with resuscitative effort accidentally led to insufficient abdominal blood flow and he developed extensive intestinal necrosis. Following surgical intervention, the patient was resuscitated; however, he developed partial intestinal necrosis and was subsequently managed with surgical intestinal resection.ConclusionsBlood supply to the abdominal organs should be considered when deploying the balloon. Further, balloon positioning, aortic occlusion time, and inflation volume should be carefully considered to avoid ischemic complications.

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

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000003106 ◽

2021 ◽

Vol 90 (5) ◽

pp. e127-e128

Author(s):

Yunus Emre Özlüer ◽

Kıvanç Karaman

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Aortic Rupture ◽

Balloon Occlusion ◽

Pressure Limit ◽

Endovascular Balloon Occlusion

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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 in a Multidisciplinary Approach

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000383 ◽

2017 ◽

Vol 12 (4) ◽

pp. e1-e2 ◽

Cited By ~ 3

Author(s):

Carolina Nilsson ◽

Linda Bilos ◽

Tal Hörer ◽

Artai Pirouzram

Keyword(s):

Multidisciplinary Approach ◽

Damage Control ◽

Damage Control Surgery ◽

Balloon Occlusion ◽

Definitive Treatment ◽

Bleeding Management ◽

Aortic Balloon Occlusion ◽

Trauma Case ◽

Management Concept ◽

Endovascular Balloon Occlusion

The usage of resuscitative endovascular balloon occlusion of the aorta, also known as aortic balloon occlusion, is an emerging method for bleeding control as a bridge to definitive treatment in trauma management. We describe a trauma case where resuscitative endovascular balloon occlusion of the aorta was used as part of the EndoVascular hybrid Trauma and bleeding Management concept to facilitate transient hemorrhage control and thereby to permit damage control surgery. The case is an illustration of the adoption of a multidisciplinary approach.

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P042: Resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma: a systematic review

CJEM ◽

10.1017/cem.2018.240 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S71-S72

Author(s):

A. Eksteen ◽

J. Odenbach ◽

C. Archer ◽

C. Domke

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Case Reports ◽

Case Series ◽

Weighted Average ◽

Injured Patient ◽

Severe Trauma ◽

Balloon Occlusion ◽

Aortic Balloon Occlusion ◽

Endovascular Balloon Occlusion

Introduction: Trauma leading to uncontrolled hemorrhage of the torso in the critically injured patient can rapidly progress to decreased cerebral and cardiovascular perfusion and carries a significant morbidity and mortality. Given the non-compressible nature and difficult anatomic access of these injuries, obtaining hemostasis is often a challenge and non-surgical options are sparse. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a rapidly administered emergency department intervention that allows transient source control of caudal torso hemorrhage while arranging definitive surgical management. Although initially postulated in the 1950s, limited research regarding its therapeutic use in trauma has been available until recently. Here, we present a systematic review of the literature pertaining to the use of REBOA in severe trauma. Methods: An experienced medical librarian searched electronic databases for terms relating to REBOA, aortic balloon occlusion, hemorrhage, trauma and shock. Articles were identified, screened, retrieved and reviewed in accordance with PRISMA systematic review guidelines. English case reports, case series, cohort studies, randomized-controlled trials, systematic reviews and meta-analyses pertaining to the use of REBOA in human trauma patients were included. Customized inclusion and data extraction forms were created and used to form an electronic database of relevant studies. Results: After exclusion of duplicates, 2147 potentially relevant articles were identified and screened by title/abstract and 136 articles meeting inclusion criteria were retrieved for full-text review. Final analysis of 26 articles included 5 case reports, 13 case series, 7 observational cohort studies and 1 systematic review. Data spanning 771 patients undergoing REBOA were collected (weighted average age: 49.5, gender: 67.7% male, injury severity score: 35.1). Where data available, REBOA increased systolic blood pressure by a weighted average of 54.7mmhg and overall survival was 32.6%. Conclusion: Limited evidence pertaining to the use of REBOA in severe trauma exists with the majority of available data coming from individual case studies and case series. By extension, quantitative analysis regarding outcome data of this intervention requires further research in the form of larger studies with subgroup analysis to identify the subset of patients for which REBOA may benefit and to further delineate the risks of implementing this intervention

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Association of resuscitative endovascular balloon occlusion of the aorta (REBOA) and mortality in penetrating trauma patients

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01370-9 ◽

2020 ◽

Cited By ~ 3

Author(s):

Alberto F. García ◽

Ramiro Manzano-Nunez ◽

Claudia P. Orlas ◽

Juan Ruiz-Yucuma ◽

Alejandra Londoño ◽

...

Keyword(s):

Penetrating Trauma ◽

Balloon Occlusion ◽

Trauma Patients ◽

Endovascular Balloon Occlusion

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Systolic blood pressure below 110mmHg is associated with increased mortality in penetrating major trauma patients: Multicentre cohort study

Resuscitation ◽

10.1016/j.resuscitation.2011.10.018 ◽

2012 ◽

Vol 83 (4) ◽

pp. 476-481 ◽

Cited By ~ 54

Author(s):

Rebecca M. Hasler ◽

Eveline Nüesch ◽

Peter Jüni ◽

Omar Bouamra ◽

Aristomenis K. Exadaktylos ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Systolic Blood Pressure ◽

Major Trauma ◽

Trauma Patients ◽

Multicentre Cohort Study ◽

Multicentre Cohort

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Assessing the need for resuscitative endovascular balloon occlusion of the aorta (REBOA) for management of non-compressible hemorrhage at a Canadian urban trauma centre

10.21203/rs.3.rs-198760/v1 ◽

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.

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