New Techniques in Hemorrhage Control

2017 ◽  
Author(s):  
Megan Brenner ◽  
Joseph DuBose
Keyword(s):  
Treatment Algorithm ◽  
Balloon Occlusion ◽  
Published Data ◽  
Solid Organ ◽  
Stent Grafting ◽  
Pelvic Hemorrhage ◽  
Key Words Angiography ◽  
Vessel Injury ◽  
Definitive Therapy ◽  
Endovascular Balloon Occlusion

The use of interventional procedures in trauma has increased steadily over the past 10 years. With advancements in both imaging and device technology, endovascular techniques have become part of the treatment algorithm for both large and small vessel injury. Endovascular therapy in trauma involves a minimally invasive, catheter-based approach, which can be used as a temporizing measure in patients in extremis or as definitive therapy in a wide variety of diagnoses. Sheaths, catheters, and guide wires are universal instruments, regardless of procedure. Devices passed over guide wires form the basis of diagnosis and treatment. Using this technology provides many advantages to traditional open surgical therapy, namely the avoidance of large and potentially morbid incisions. Angioembolization, stent grafting, and resuscitative endovascular balloon occlusion of the aorta (REBOA) are being used with increasing frequency in trauma centers, with established algorithms, multiinstitutional trials, and more published data available, particularly for solid-organ and pelvic hemorrhage. Key words: angiography, embolization, hemorrhage, resuscitative endovascular balloon occlusion of the aorta, stent graft

New Techniques in Hemorrhage Control

2017 ◽  
Author(s):  
Megan Brenner ◽  
Joseph DuBose
Keyword(s):  
Treatment Algorithm ◽  
Balloon Occlusion ◽  
Published Data ◽  
Solid Organ ◽  
Stent Grafting ◽  
Pelvic Hemorrhage ◽  
Key Words Angiography ◽  
Vessel Injury ◽  
Definitive Therapy ◽  
Endovascular Balloon Occlusion

The use of interventional procedures in trauma has increased steadily over the past 10 years. With advancements in both imaging and device technology, endovascular techniques have become part of the treatment algorithm for both large and small vessel injury. Endovascular therapy in trauma involves a minimally invasive, catheter-based approach, which can be used as a temporizing measure in patients in extremis or as definitive therapy in a wide variety of diagnoses. Sheaths, catheters, and guide wires are universal instruments, regardless of procedure. Devices passed over guide wires form the basis of diagnosis and treatment. Using this technology provides many advantages to traditional open surgical therapy, namely the avoidance of large and potentially morbid incisions. Angioembolization, stent grafting, and resuscitative endovascular balloon occlusion of the aorta (REBOA) are being used with increasing frequency in trauma centers, with established algorithms, multiinstitutional trials, and more published data available, particularly for solid-organ and pelvic hemorrhage. Key words: angiography, embolization, hemorrhage, resuscitative endovascular balloon occlusion of the aorta, stent graft

Resuscitative endovascular balloon occlusion of the aorta (REBOA) enables operative management of the peripartum trauma patient in hemorrhagic shock

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Kelvin Allenson ◽  
Laura Moore
Keyword(s):  
Maternal Death ◽  
Motor Vehicle ◽  
Operative Management ◽  
Balloon Occlusion ◽  
Motor Vehicle Accidents ◽  
Gravid Uterus ◽  
Intrauterine Pregnancy ◽  
Vehicle Accidents ◽  
Pelvic Hemorrhage ◽  
Endovascular Balloon Occlusion

Trauma related injury is the leading cause of non-obstetric maternal death.  The gravid uterus is at risk for injury, particularly during motor vehicle accidents.  Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a means of controlling pelvic hemorrhage in the setting of trauma.  We report the use of REBOA in a hemodynamically unstable, multiply-injured young woman with viable intrauterine pregnancy.

Endovascular Retrograde Suction Decompression as an Adjunct to Surgical Treatment of Ophthalmic Aneurysms: Analysis of Risks and Clinical Outcomes

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS107-ONS112 ◽  
Author(s):  
Daniel H. Fulkerson ◽  
Terry G. Horner ◽  
Troy D. Payner ◽  
Thomas J. Leipzig ◽  
John A. Scott ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Statistical Difference ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
The Other ◽  
Published Data ◽  
Intraoperative Angiography ◽  
Technical Aspects ◽  
Endovascular Balloon Occlusion

Abstract Objective: Endovascular retrograde suction decompression with balloon occlusion of the internal carotid artery is a useful adjunct in the surgical treatment of ophthalmic aneurysms. This technique helps establish proximal control, facilitates intraoperative angiography and may aid dissection by evacuating blood and softening the aneurysm. Although the technical aspects of this procedure have been described, the published data on its safety are scant. This study analyzed 2 groups of patients who underwent craniotomies for treatment of ophthalmic aneurysms, comparing a group who received suction decompression with a group who did not. Methods: A retrospective analysis of prospectively collected data on 118 craniotomies for ophthalmic aneurysms performed from 1990 to 2005 is presented. A group of 63 patients treated with endovascular suction decompression during surgery is compared with 55 patients who did not undergo this technique. Results: In our overall analysis of ophthalmic aneurysms, the clinical outcome was statistically related to aneurysm size (P = 0.046). The endovascular suction decompression group in this study had overall larger aneurysms (P < 0.0001) compared with the other group. There was no statistical difference between the 2 groups in rates of complications, stroke, new visual deficit, or death. The clinical outcomes were statistically similar at discharge and at 1 year. Conclusion: Endovascular balloon occlusion and suction decompression did not increase the complication rate in a large cohort of craniotomy patients with ophthalmic aneurysms. This technique may be used to augment surgical capabilities without significantly increasing the operative risk.

Efficacy of intermittent versus standard resuscitative endovascular balloon occlusion of the aorta in a lethal solid organ injury model

2019 ◽  
Vol 87 (1) ◽  
pp. 9-17 ◽  
Author(s):  
John Kuckelman ◽  
Michael Derickson ◽  
Morgan Barron ◽  
Cody J. Phillips ◽  
Donald Moe ◽  
...  
Keyword(s):  
Balloon Occlusion ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Injury Model ◽  
Endovascular Balloon Occlusion

Approximation of Pediatric Morphometry for Resuscitative Endovascular Balloon Occlusion of the Aorta

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Erik Scott DeSoucy ◽  
Alfred Francois Trappey ◽  
Andrew M Wishy ◽  
Meryl A Simon ◽  
Anders J Davidson ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Pediatric Patients ◽  
Balloon Catheter ◽  
Vessel Diameter ◽  
Balloon Occlusion ◽  
Solid Organ ◽  
Regression Equations ◽  
Access Site ◽  
Normal Ranges ◽  
Endovascular Balloon Occlusion

Background Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be beneficial in the management of traumatic and iatrogenic vascular and solid organ injuries in children, but requires an understanding of vessel diameter at the access site and landing zones. We sought to adapt the Broselow™ Tape method to estimation of aortic and femoral artery diameters for this purpose. Methods Computed tomography scans from trauma and non-trauma pediatric patients at a level 1 trauma center were reviewed for vascular dimensions at aorta Zone I, Zone III and the common femoral artery (CFA). Vessel size was measured by two providers using a vascular software suite with a 10% interobserver comparison. Height was used to create linear regression equations for each location and calculate ranges for each Broselow™ Tape category. Results We reviewed scans from 110 patients ages 2-14 years with less than 8% interobserver variability. 64% were male and 46% were trauma patients. Height based regression equations were closely correlated with vessel diameter:  Zone I(mm)=[0.093±0.006·height(cm)]+0.589±0.768; R2=0.714, p<0.001 Zone III(mm)=[0.083±0.005·height(cm)]–0.703±0.660; R2=0.728, p<0.001 CFA(mm)=[0.043±0.003·height(cm)]+0.644±0.419; R2=0.642, p<0.001 These equations, along with the minimum and maximum length for each Broselow™ Tape color, were used to define color coded normal ranges for each REBOA landing zone and access site. Conclusion Knowledge of the access vessel and occlusion zone diameters in pediatric patients is crucial for future research and application of REBOA in this population. Furthermore, an adapted Broselow™ Tape including these measurements would assist in appropriate sheath and balloon catheter selection in emergent settings.

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.

Successful Control of Massive Vaginal Bleeding with Resuscitative Endovascular Balloon Occlusion of the Aorta and Pelvic Packing

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Emre Özlüer ◽  
Çagaç Yetis ◽  
Evrim Sayin ◽  
Mücahit Avcil
Keyword(s):  
Vaginal Bleeding ◽  
Balloon Occlusion ◽  
Emergency Physicians ◽  
Pelvic Packing ◽  
Gynecological Malignancies ◽  
Life Threatening ◽  
Successful Control ◽  
Endovascular Balloon Occlusion

Gynecological malignancies may present as life-threatening vaginal bleeding. Pelvic packing and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful along with conventional vaginal packing when in terms of control of the hemorrhage. Emergency physicians should be able to perform these interventions promptly in order to save their patients from exsanguination.

AORTA Registry 7F vs 11-12 F access

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Reviewer Joseph DuBose ◽  
Jonathan Morrison ◽  
Megan Brenner ◽  
Laura Moore ◽  
John B Holcomb ◽  
...  
Keyword(s):  
Ultrasound Guidance ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Severely Injured ◽  
Distal Extremity ◽  
Low Profile ◽  
Transfusion Requirements ◽  
Thrombotic Complications ◽  
Device Use ◽  
Endovascular Balloon Occlusion

ABSTRACT Introduction:  The introduction of low profile devices designed for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) after trauma has the potential to change practice, outcomes and complication profiles related to this procedure. Methods: The AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was utilized to identify REBOA patients from 16 centers -comparing presentation, intervention and outcome variables for those REBOA via traditional 11-12 access platforms and trauma-specific devices requiring only 7 F access. Results:From Nov 2013-Dec 2017, 242 patients with completed data were identified, constituting 124 7F and 118 11-12F uses. Demographics of presentation were not different between the two groups, except that the 7F patients had a higher mean ISS (39.2 34.1, p = 0.028). 7F device use was associated with a lower cut-down requirement for access (22.6% vs. 37.3%, p = 0.049) and increased ultrasound guidance utilization (29.0% 23.7%, p = 0.049). 7F device afforded earlier aortic occlusion in the course of resuscitation (median 25.0 mins vs. 30 mins, p = 0.010), and had lower median PRBC (10.0 vs. 15.5 units, p = 0.006) and FFP requirements (7.5 vs. 14.0 units, p = 0.005). 7F patients were more likely to survive 24 hrs (58.1% vs. 42.4%, p = 0.015) and less likely to suffer in-hospital mortality (57.3% vs. 75.4%, p = 0.003). Finally, 7F device use was associated with a 4X lower rate of distal extremity embolism (20.0% vs. 5.6%, p = 0.014;OR 95% CI 4.25 [1.25-14.45]) compared to 11-12F counterparts. Conclusion: The introduction of trauma specific 7F REBOA devices appears to have influenced REBOA practices, with earlier utilization in severely injured hypotensive patients via less invasive means that are associated with lower transfusion requirements fewer thrombotic complications and improved survival. Additional study is required to determine optimal REBOA utilization.

Sign in / Sign up

Export Citation Format

Share Document