Resuscitative Endovascular Balloon Occlusion of the Aorta: Principles, Initial Clinical Experience, and Considerations for the Anesthesiologist (original) (raw)
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Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma
Colombian Journal of Anesthesiology, 2017
Introduction: Non-compressible torso haemorrhage is the leading cause of death in trauma cases. This has led to the development of new devices to control bleeding, including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Objective: To perform a non-systematic review of the literature on the use of Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma. Materials and methods: A systematic literature search through Medline was conducted. Articles relevant to our objective were selected. A qualitative and narrative synthesis of results is presented. Results: Our qualitative and narrative results show that Resuscitative Endovascular Balloon Occlusion of the Aorta could be a safe and effective intervention for the control of haemorrhage in abdomino-pelvic trauma. Its use is controversial in thoracic trauma. Finally, the performance of this intervention may cause complications. Conclusion: Resuscitative Endovascular Balloon Occlusion of the Aorta is an alternative that can be used in damage control surgery. It could be effective for early control of bleeding in patients with non-compressible torso haemorrhage. As a complex intervention, REBOA
The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
World journal of emergency surgery : WJES, 2018
Non-compressible torso hemorrhage (NCTH) remains a significant cause of morbidity and mortality in the field of trauma and emergency medicine. In recent times, there has been a resurgence in the adoption of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for patients who present with NCTH. Like all medical procedures, there are benefits and risks associated with the REBOA technique. However, in the case of REBOA, these complications are not unanimously agreed upon with varying viewpoints and studies. This article aims to review the current knowledge surrounding the complications of the REBOA technique at each step of its application.
Resuscitative endovascular balloon occlusion of the aorta (REBOA)
The journal of trauma and acute care surgery, 2015
The worldwide impact of traumatic injury and associated hemorrhage on human health and well-being is significant. Methods to manage bleeding from sites within the torso, referred to as non-compressible torso hemorrhage (NCTH), remain largely limited to the use of conventional operative techniques. The overall mortality rate of patients with NCTH is approximately 50%. Studies from the wars in Afghanistan and Iraq have suggested that up to 80% of potentially survivable patients die as a result of uncontrolled exsanguinating hemorrhage. The commercially available resuscitative endovascular balloon occlusion of the aorta (REBOA) is a percutaneous device for the rapid control of torso hemorrhage in trauma. A compliant balloon is inserted via the femoral artery and inflated in the thoracic or abdominal aorta, providing inflow control of the abdomen, pelvis, or groin/lower extremities. Recent studies indicate that REBOA carries an inherent risk of aortic injury due to over-inflation and possible risk of aortic or iliac artery rupture. A new approach is to resolve the issue of balloon sizing and over-inflation. We propose a novel concept to be used in trauma facility for arterial occlusion to eliminate arterial injury and the risk of vascular rupture through real time balloon diameter profile measurements to ensure proper inflation. The proposed concept, called Smart Resuscitative Endovascular Balloon Occlusion (SREBO) will be novel in the following aspects: 1) It will have electrical conductance-based navigation technology to target the desired site of balloon deployment in the aorta, 2) The balloon can determine the time of proper inflation using electrical conductance catheter technology. This technology would eliminate the risk of arterial rupture and simplify the procedure in the trauma facility or medical clinics without significant training. The results can be displayed on a handheld device. This novel device has the potential to save civilians in trauma or soldiers injured on the battlefield.
Journal of Chest Surgery
See Commentary page 117. Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has recently gained popularity as an adjunct to resuscitation of patients with traumatic shock. However, the effectiveness of REBOA is still debated because of inconsistent indications across centers and the lack of medical records. The purpose of this study was to investigate the effectiveness and feasibility of REBOA by analyzing clinical results from a single center. Methods: This study included 96 patients who underwent REBOA between August 2016 and September 2021 at a regional trauma center according to the center's treatment algorithm for traumatic shock. Medical records, including the time of the decision to conduct the REBOA procedure, time of operation, type of aortic occlusion, and clinical outcomes, were collected prospectively and analyzed retrospectively. Patients were classified by RE-BOA protocol (group 1, 2, or 3) and survival status (survivor or non-survivor) for analysis. Results: The overall success rate of the procedure was 97.9%, and the survival rate was 32.6%. In survivors, blood pressure was higher than in non-survivors both before the RE-BOA procedure (p=0.002) and after aortic occlusion (p=0.03). The total aortic occlusion time was significantly shorter (p=0.001) and the proportion of partial aortic occlusion was significantly higher (p=0.014) among the survivors. The non-survivors had more acidosis (p<0.001) and higher lactate concentrations (p<0.001) than the survivors. Conclusion: REBOA may be a feasible bridge therapy for resuscitation of patients with traumatic shock. Prompt and accurate decision-making to perform REBOA followed by damage control surgery could improve survival rates and clinical outcomes.
Canadian Journal of Emergency Medicine
Objective Uncontrolled hemorrhage poses significant morbidity and mortality among injured patients. Resuscitative endovascular balloon occlusion of the aorta (REBOA) utilizes a rapidly-administered minimally invasive transfemoral balloon catheter that is inflated for aortic occlusion, allowing for time to arrange definitive surgical or angiographic intervention. As indications for its use continue to evolve, this study sought to evaluate whether there is a potential need for REBOA implementation in two high-volume trauma centers in Edmonton. Methods Patient data within our provincial trauma registry was reviewed between 2015 and 2017 to identify major trauma patients (Injury Severity Score ≥ 12). Patients eligible for REBOA included patients with blunt or penetrating trauma to the torso or pelvis, AND death prior to discharge; and patients taken to the operating room or interventional radiology suite within 4 h of arrival. Charts were reviewed to determine if patients met current conventional criteria for REBOA. Results Out of 3415 trauma patients during our study period, 237 patients met the registry screen as potentially eligible for REBOA. After primary researcher review, 67 patients underwent full chart review and then 2 trauma surgeons determined that 38 (1.1% of the study population) met criteria for deploying REBOA. Conclusion A small but significant number of trauma patients at the two trauma centers were identified as potential candidates for REBOA use. Implementation of a REBOA program should be done in alignment with existing clinical practice guidelines and professional society recommendations.