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The pitfalls of resuscitative endovascular balloon occlusion of the aorta: Risk factors and mitigation strategies

Davidson, Anders, J., MD, MAS; Russo, Rachel, M., MD, MAS; Reva, Viktor, A., MD; Brenner, Megan, L., MD; Moore, Laura, J., MD; Ball, Chad, MD; Bulger, Eileen, MD; Fox, Charles, J., MD; DuBose, Joseph, J., MD; Moore, Ernest, E., MD; Rasmussen, Todd, E., MDthe BEST Study Group

Journal of Trauma and Acute Care Surgery: January 2018 - Volume 84 - Issue 1 - p 192–202
doi: 10.1097/TA.0000000000001711
Review Articles

ABSTRACT Despite technological advancements, REBOA is associated with significant risks due to complications of vascular access and ischemia-reperfusion. The inherent morbidity and mortality of REBOA is often compounded by coexisting injury and hemorrhagic shock. Additionally, the potential for REBOA-related injuries is exaggerated due to the growing number of interventions being performed by providers who have limited experience in endovascular techniques, inadequate resources, minimal training in the technique, and who are performing this maneuver in emergency situations. In an effort to ultimately improve outcomes with REBOA, we sought to compile a list of complications that may be encountered during REBOA usage. To address the current knowledge gap, we assembled a list of anecdotal complications from high-volume REBOA users internationally. More importantly, through a consensus model, we identify contributory factors that may lead to complications and deliberate on how to recognize, mitigate, and manage such events. An understanding of the pitfalls of REBOA and strategies to mitigate their occurrence is of vital importance to optimize patient outcomes.

From the University of California Davis (A.J.D., R.M.R., J.J.D.), Sacramento, California; Kirov Military Medical Academy (V.A.R.), Saint-Petersburg, Russian Federation; R Adams Cowley Shock Trauma Medical Center (M.L.B.), Baltimore, Maryland; University of Texas Health Science Center (L.J.M.), Houston, Texas; Foothills Medical Centre (C.B.), University of Calgary, Calgary, Alberta, Canada; Harborview Medical Center (E.B.), University of Washington, Seattle, Washington; Denver Health (E.E.M.), Denver, Colorado; Uniformed Services (T.E.R.), University of the Health Sciences, Bethesda, Maryland.

Submitted: June 11, 2017, Revised: July 20, 2017, Accepted: September 19, 2017, Published online: October 19, 2017.

The views expressed in this material are those of the authors and do not reflect the official policy or position of the US Government, the Department of Defense, the Department of the Air Force, or any of the affiliated institutions.

The BEST Study Group (in alphabetical order): Chad Ball, MD, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada (ball.chad@gmail.com); Megan L. Brenner, MD, R Adams Cowley Shock Trauma Medical Center, Baltimore, Maryland (mbrenner@umm.edu); Eileen Bulger, MD, Harborview Medical Center, University of Washington, Seattle, Washington (ebulger@uw.edu); Anders J. Davidson, MD, MAS, University of California Davis, Sacramento, California (ajdavidson@ucdavis.edu); Joseph J. DuBose, MD, University of California Davis (jjd3c@yahoo.com); Charles J. Fox, MD, University of Colorado Denver, Denver, Colorado (charles.fox@dhha.org); Joseph M. Galante, MD, University of California Davis (jmgalante@ucdavis.edu); Melanie Hoehn, MD, R Adams Cowley Shock Trauma Medical Center (mhoehn@smail.umaryland.edu); Tal M. Hörer, MD, PhD, Örebro University Hospital, Örebro, Sweden (Tal.horer@regionorebrolan.se); M. Austin Johnson, MD, PhD, University of California Davis (m.austin.johnson@gmail.com); Boris Kessel, MD, Hillel Yaffe Medical Center, Hadera, Israel (bkkessel01@gmail.com); David E. Leshikar, MD, University of California Davis (deleshikar@ucdavis.edu); Junichi Matsumoto, MD, St Marianna University School of Medicine, Kawasaki, Japan (docjun0517@gmail.com); Yosuke Matsumura, MD, R Adams Cowley Shock Trauma Medical Center (yousuke.jpn4035@gmail.com); Ernest E. Moore, MD, University of Colorado Denver (ernest.moore@dhha.org); Laura J. Moore, MD, University of Texas Health Science Center, Houston, Texas (Laura.J.Moore@uth.tmc.edu); Lucas P. Neff, MD, Emory University, Atlanta, Georgia (lpneff@emory.edu); Jason Pasley, DO, R Adams Cowley Shock Trauma Medical Center (jpasley@umm.edu); Todd E. Rasmussen, MD, Uniformed Services University of the Health Sciences, Bethesda, Maryland (todd.rasmussen@usuhs.edu); Viktor A. Reva, MD, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation (vreva@mail.ru); Rachel M. Russo, MD, MAS, University of California Davis (rmrusso@ucdavis.edu); Edgardo S. Salcedo, MD, University of California Davis (esalcedo@ucdavis.edu); Thomas Scalea, MD, R Adams Cowley Shock Trauma Medical Center (tscalea@umm.edu); Nam T. Tram, MD, Harborview Medical Center, University of Washington (nam@uw.edu); Jason M. Weinberger, DO, R Adams Cowley Shock Trauma Medical Center (JasonWeinberger@umm.edu); and Timothy K. Williams, MD, Wake Forest Baptist Health, Winston-Salem, North Carolina (timothykeithwilliams@gmail.com).

Address for reprints: Lt Col Joseph J. DuBose, MD, USAF MC, Department of Vascular and Endovascular Surgery, David Grant Medical Center, 101 Bodin Cir, Travis Air Force Base, CA 94535; email: jjd3c@yahoo.com.

© 2018 Lippincott Williams & Wilkins, Inc.