A Clinical Series of Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhage Control and Resuscitation
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND A requirement for improved methods of hemorrhage control and resuscitation along with the translation of endovascular specialty skills has resulted in reappraisal of resuscitative endovascular balloon occlusion of the aorta REBOA for end-stage shock. The objective of this report was to describe implementation of REBOA in civilian trauma centers. METHODS Descriptive case series of REBOA December 2012 to March 2013 used in scenarios of end-stage hemorrhagic shock at the University of Maryland, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland, and Herman Memorial Hospital, The Texas Trauma Institute, Houston, Texas. RESULTS REBOA was performed by trauma and acute care surgeons for blunt n 4 and penetrating n 2 mechanisms. Three cases were REBOA in the descending thoracic aorta Zone I and three in the infrarenal aorta Zone III. Mean SD systolic blood pressure at the time of REBOA was 59 27 mm Hg, and mean SD base deficit was 13 5. Arterial access was accomplished using both direct cutdown n 3 and percutaneous n 3 access to the common femoral artery. REBOA resulted in a mean SD increase in blood pressure of 55 20mmHg, and the mean SD aortic occlusion time was 18 34 minutes. There were no REBOA-related complications, and there was no hemorrhage-related mortality. CONCLUSION REBOA is a feasible and effective means of proactive aortic control for patients in end-stage shock from blunt and penetrating mechanisms. With available technology, this method of resuscitation can be performed by trauma and acute care surgeons who have benefited from instruction on a limited endovascular skill set. Future work should be aimed at devices that allow easy, fluoroscopy-free access and studies to define patients most likely to benefit from this procedure.
- Anatomy and Physiology
- Medicine and Medical Research