Southwestern Surgical CongressResuscitative endovascular balloon occlusion of the aorta for control of noncompressible truncal hemorrhage in the abdomen and pelvis
Section snippets
Patients and Methods
We retrospectively identified all patients that underwent REBOA at The Texas Trauma Institute, an American College of Surgeons–verified Level 1 Trauma Center in Houston, Texas between October 2011 and September 2015. Inclusion criteria were all patients that underwent REBOA during the study period. No patients that underwent REBOA were excluded from the study. Demographic data, mechanism of injury, injury severity score (ISS), Abbreviated Injury Scale, admission vital signs/laboratory values,
Results
Over the course of the 48-month study period, a total of 31 patients underwent REBOA. The median age of REBOA patients was 47 years of age (IQR 27 to 63). Seventy-seven percent of the patients were male and 87% had a blunt mechanism of injury. The median ISS was 34 (IQR = 22 to 42) and the overall survival rate was 32%. Of the 31 patients, 10 patients had cardiopulmonary resuscitation (CPR) in progress at the time of REBOA insertion.
Of the 21 deaths, 2 (9.5%) occurred in the ER, 7 (33%)
Comments
This clinical series represents the largest single center series from the United States on the contemporary use of REBOA as an adjunct for patients with hemorrhagic shock arising below the diaphragm. Although there has been a recent resurgence in the use of REBOA, the concept of aortic balloon occlusion is not new. In a 1954 case series, Lieutenant Colonel Carl Hughes first described the use of aortic balloon occlusion in 3 soldiers with intra-abdominal hemorrhage during the Korean War.16 With
Conclusions
Resuscitative endovascular balloon occlusion of the Aorta is an effective method for achieving temporary aortic occlusion in trauma patients with noncompressible torso hemorrhage arising from below the diaphragm. Balloon inflation in both zone 1 and zone 3 occlusions results in an increase in SBP. In addition, REBOA inflation during CPR resulted in return of spontaneous circulation in 60% of the patients. Despite the high-injury severity seen in this population, the overall survival rate was
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2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
2023, Journal of Thoracic and Cardiovascular SurgeryWorse outcomes with resuscitative endovascular balloon occlusion of the aorta in severe pelvic fracture: A matched cohort study
2023, American Journal of Surgery2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines
2022, Journal of the American College of CardiologyREBOA utility
2022, Surgery Open ScienceCitation Excerpt :As a result, clear indications and contraindications for its role have not been fully established. High-quality evidence regarding its ability to improve survival and long-term outcomes compared to contemporary trauma care is lacking [5,11–13]. Expert consensus suggests that its primary role is to act as a bridge to definitive hemorrhage control in situations of refractory hypovolemic shock secondary to acute subdiaphragmatic bleeding [7,14].
There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.
The authors declare no conflicts of interest.