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A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation

Brenner, Megan L. MD; Moore, Laura J. MD; DuBose, Joseph J. MD; Tyson, George H. MD; McNutt, Michelle K. MD; Albarado, Rondel P. MD; Holcomb, John B. MD; Scalea, Thomas M. MD; Rasmussen, Todd E. MD

Journal of Trauma and Acute Care Surgery: September 2013 - Volume 75 - Issue 3 - p 506–511
doi: 10.1097/TA.0b013e31829e5416
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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 (20) mm Hg, 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.

LEVEL OF EVIDENCE Therapeutic study, level V.

From the R Adams Cowley Shock Trauma Center (M.L.B., J.J.D., T.M.S.), University of Maryland; The Uniformed Service University of the Health Sciences (T.E.R., J.J.D.), Baltimore, Maryland; Texas Trauma Institute (L.J.M., J.B.H., M.K.M., R.P.A., G.H.T.), University of Texas at Houston, Houston; and US Army Institute of Surgical Research (T.E.R.), Joint Base Fort Sam Houston, San Antonio, Texas.

Submitted: May 6, 2013, Revised: May 29, 2013, Accepted: May 30, 2013.

The views expressed in this article are those of the authors and do not reflect official positions or policy of the US Government, the Department of Defense, or the US Air Force.

Address for reprints: Todd E. Rasmussen, MD, US Army Institute of Surgical Research, Joint Base Fort Sam Houston, Texas; email: todd.e.rasmussen.mil@mail.mil.

© 2013 Lippincott Williams & Wilkins, Inc.