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

2019 ◽  
pp. 102490791986656 ◽  
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.

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

2019 ◽  
Vol 85 (6) ◽  
pp. 654-662 ◽  
Author(s):  
Patrizio Petrone ◽  
Aida PÉRez-JimÉNez ◽  
Martín Rodríguez-Perdomo ◽  
Collin E. M. Brathwaite ◽  
D'andrea K. Joseph
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Single Case ◽  
Case Reports ◽  
Balloon Occlusion ◽  
Definitive Treatment ◽  
Trauma Patients ◽  
Aortic Balloon Occlusion ◽  
Number Of Patients ◽  
Endovascular Balloon Occlusion

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.

REBOA Use, Practices, Characteristics, and Implementations Across Various US Trauma Centers

2021 ◽  
pp. 000313482098881
Author(s):  
Mason Sutherland ◽  
Aaron Shepherd ◽  
Kyle Kinslow ◽  
Mark McKenney ◽  
Adel Elkbuli
Keyword(s):  
Online Survey ◽  
Patient Characteristics ◽  
Balloon Occlusion ◽  
Common Mechanism ◽  
Pelvic Hemorrhage ◽  
Frequency Of Use ◽  
Trauma Surgeons ◽  
Trauma Bay ◽  
Current Guidelines ◽  
Endovascular Balloon Occlusion

Background Hemorrhage accounts for >30% of trauma-related mortalities. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for temporary hemostasis in the civilian population remains controversial. We aim to investigate REBOA practices through analysis of surgeon and trauma center characteristics, implementation, patient characteristics, and overall opinions. Methods An anonymous 30-question standardized online survey on REBOA use was administered to active trauma surgeon members of the Eastern Association for the Surgery of Trauma. Results A total of 345 responses were received, and 130/345 (37.7%) reported REBOA being favorable, 42 (12.2%) reported REBOA unfavorably, and 173 (50.1%) were undecided. The majority of respondents (87.6%) reported REBOA performance in the trauma bay. 170 (49.3%) of respondents reported having deployed REBOA at least once over the past 2 years. 80.0% reported blunt trauma being the most common mechanism of injury in REBOA patients. Resuscitative endovascular balloon occlusion of the aorta deployment in zone 3 of the aorta was significantly higher in patients reported to suffer a pelvic fracture or pelvic hemorrhage, whereas REBOA deployment in zone 1 was significantly higher among patients reported to suffer hepatic, splenic, or other intra-abdominal hemorrhage ( P < .05). Conclusion Among survey respondents, frequency of REBOA use was low along with knowledge of clear indications for use. While current REBOA usage among respondents appeared to model current guidelines, additional research regarding REBOA indications, ideal patient populations, and outcomes is needed in order to improve REBOA perception in trauma surgeons and increase frequency of use.

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

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.

scholarly journals Resuscitative Endovascular Balloon Occlusion of the Aorta: Assessing Need in an Urban Trauma Center

2019 ◽  
Vol 233 ◽  
pp. 413-419 ◽  
Author(s):  
Ryan P. Dumas ◽  
Daniel N. Holena ◽  
Brian P. Smith ◽  
Daniel Jafari ◽  
Mark J. Seamon ◽  
...  
Keyword(s):  
Trauma Center ◽  
Balloon Occlusion ◽  
Endovascular Balloon Occlusion

scholarly journals 23. Ambulance Sphygmomanometer Accuracy: Can It Affect Triage to the Trauma Center?

1996 ◽  
Vol 11 (S2) ◽  
pp. S33-S33
Author(s):  
Charles E. Cady ◽  
Ronald G. Pirrallo ◽  
Clarence E. Grim
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blunt Trauma ◽  
Frequency Distribution ◽  
Trauma Center ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Industry Standards ◽  
Study Population ◽  
The Mean

Objectives: To determine the accuracy of sphygmomanometers (SPHYGs) from a metropolitan EMS system and quantitate the mis-triage of adult blunt trauma patients based on erroneous systolic blood pressure (SBP) readings.Methods-A: A cross-sectional, convenient sample of 150 SPHYGs was checked for accuracy using industry standards. Mean high and low deviations were calculated at 90 mmHg.Methods-B: Retrospectively, a frequency distribution of the initial SBPs of all blunt trauma patients, age ≥21, seen in 1994 was plotted to characterize our study population. The numbers of patients potentially over- or under-triaged were identified when their reported SBP was corrected for using the mean high and low deviation plus 2 SDs.Results-A: Overall, 25.3% of the SPHYGs were inaccurate. At 90 mmHg, 28.0% (42/150) were inaccurate with 16.7% (7/42) high by 4.6±1.5 mmHg and 81.0% (34/42) low by 6.2±4.2 mmHg; one was inoperable.Results-B: 1,005 adult blunt trauma patients were evaluated; 61 were eliminated: 35 had initial SBPs of 0 mmHg and 26 had no SBP recorded (n = 944). The mean initial SBP was 138 ±30mmHg, and 3.8% (36/944) of the patients had SBPs <90 mmHg. Potentially, 2.0% (19/944) of the patients were undertriaged (initial erroneously high SBP reading 90–98 mmHg) and 2.5% (24/944) over-triaged (initial erroneously low SBP reading 74–90 mmHg).

scholarly journals Resuscitative endovascular balloon occlusion of the aorta (REBOA): indications: advantages and challenges of implementation in traumatic non-compressible torso hemorrhage

2019 ◽  
Vol 4 (1) ◽  
pp. e000262 ◽  
Author(s):  
Omar Bekdache ◽  
Tiffany Paradis ◽  
Yu Bai He Shen ◽  
Aly Elbahrawy ◽  
Jeremy Grushka ◽  
...  
Keyword(s):  
Trauma Center ◽  
Damage Control ◽  
Balloon Occlusion ◽  
Control Measures ◽  
Scoping Reviews ◽  
Level I ◽  
A New Technique ◽  
First Time ◽  
Substantial Heterogeneity ◽  
Endovascular Balloon Occlusion

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is regaining popularity in the treatment of traumatic non-compressible torso bleeding. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic.MethodsCritical search from MEDLINE, EMBASE, BIOSIS, COCHRANE CENTRAL, PUBMED and SCOPUS were conducted from the earliest available dates until March 2018. Evidence-based articles, as well as gray literature at large, were analyzed regardless of the quality of articles.ResultsWe identified 1176 articles related to the topic from all available database sources and 57 reviews from the gray literature search. The final review yielded 105 articles. Quantitative and qualitative variables included patient demographics, study design, study objectives, methods of data collection, indications, REBOA protocol used, time to deployment, zone of deployment, occlusion time, complications, outcome, and the level of expertise at the concerned trauma center.ConclusionGrowing levels of evidence support the use of REBOA in selected indications. Our data analysis showed an advantage for its use in terms of morbidities and physiologic derangement in comparison to other resuscitation measures. Current challenges remain in the selective application, implementation, competency assessment, and credentialing for the use of REBOA in trauma settings. The identification of the proper indication, terms of use, and possible advantage of the prehospital and partial REBOA are topics for further research.Level of evidenceLevel III.

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