Resuscitative Endovascular Balloon of the Aorta is feasible in penetrating chest trauma with major hemorrhage (original) (raw)

Journal of Trauma and Acute Care Surgery, 2020

Abstract

BACKGROUND Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an emerging option for hemorrhage control, but its use is limited in scenarios such as penetrating chest trauma. The aim of this study was to describe the use of REBOA as a resuscitative adjunct in these cases with major hemorrhage and to propose a new clinical management algorithm. METHODS This was a prospective, observational study conducted at a single level I trauma center in Colombia. We included all patients greater than 14 years of age with severe trauma who underwent REBOA from January, 2015 to December, 2019. Patients received REBOA if they were in hemorrhagic shock and were unresponsive to resuscitation. RESULTS A total of 56 patients underwent REBOA placement of which 37 had penetrating trauma, and 23 had chest trauma. All patients were hemodynamically unstable upon arrival to the emergency department, median of systolic blood pressure of 69 (IQR: 57-90) mm Hg and median ISS was 25 (IQR: 25-41). All REBOA's were deployed and inflated in Zone 1, median inflation time was 40 minutes (IQR:26-55), and no adverse neurologic outcomes were observed. Fifteen patients had REBOA and a median sternotomy. Eleven patients had concomitant abdominal wounds. Overall mortality was 28.6% and there was no significant difference between penetrating versus blunt trauma patients (21.6% vs 42.1%, p = 0.11). The survival rate of thoracic injured patients was similar to the predicted survival (65.2 % vs 63.3%). CONCLUSION REBOA can be used safely in penetrating chest trauma and the implementation of a REBOA management algorithm is feasible with a well-trained multidisciplinary team. LEVEL OF EVIDENCE V, therapeutic.

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