Balloon occlusion of the descending aorta in the treatment of severe post‐partum haemorrhage

Harma, Müge; Harma, Mehmet; Kunt, Alper Sami; Andaç, Mehmet Halit; Demir, Nurettin

doi:10.1111/j.1479-828x.2004.00181.x

Cited by 47 publications

(27 citation statements)

References 14 publications

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“…Recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as an alternative method of ACC. REBOA has been previously described as useful for hemorrhagic shock in cases of ruptured abdominal aortic aneurysm [2], gastrointestinal bleeding [3], and in postpartum hemorrhage [4]. As they are useful in solving multiple problems, endovascular approaches such as trans-catheter arterial embolization (TAE) should become more widely used in trauma settings.…”

Section: Introductionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta versus aortic cross clamping among patients with critical trauma: a nationwide cohort study in Japan

et al. 2016

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BackgroundMeasures of aortic occlusion (AO) for resuscitation in patients with severe torso trauma remain controversial. Our aim was to characterize the current use of resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative open aortic cross-clamping (ACC), and to evaluate whether REBOA should be an alternative method to resuscitative open ACC.MethodsThis study was a retrospective cohort study between 2004 and 2013 from a nationwide trauma registry in Japan. Participants were selected who underwent either REBOA or ACC. Their characteristics, interventions, and outcomes were analyzed to compare REBOA and ACC directly. The primary outcome was in-hospital mortality and the secondary outcome was mortality in the emergency department. Logistic regression analysis was performed to compare the outcomes between REBOA and ACC with adjustment for severity; 1:1 propensity score matching was also performed.ResultsOf the 159,157 trauma patients, 903 were eligible based on the selection criteria. Overall, 405/607 patients (67%) who had REBOA died compared to 210/233 patients (90%) who had ACC. Patients with REBOA had higher revised trauma score (RTS) (mean ± SD, 5.2 ± 2.0 vs. 4.2 ± 2.2; P < 0.001) but higher Injury Severity Score (ISS) (median (interquartile); 34 (25) vs. 34 (20); P < 0.001), and higher probability of survival (0.43 ± 0.36 vs. 0.27 ± 0.30; P < 0.001) compared to those with ACC. REBOA had an odds ratio (OR) for in-hospital mortality of 0.309 (95% confidence interval (CI) = 0.190–0.502) adjusting for trauma and injury severity score using a logistic regression model (n = 903). Similar associations were observed adjusting for RTS (OR = 0.224; 95% CI = 0.129–0.700) or adjusting for ISS (OR, 0.188; 95% CI, 0.116 to 0.303). In the propensity score-matched cohort (n = 304), REBOA was associated with lower mortality compared to ACC (OR, 0.261; 95% CI, 0.130 to 0.523). Patients with REBOA had less severe chest complications than those with ACC (Abbreviated Injury Scale thorax, 3.8 ± 0.8 vs. 4.2 ± 0.8; P < 0.001), although physiological severity and backgrounds were similar in this population.ConclusionsPatients who underwent AO had a high mortality. REBOA might be a favorable alternative method to resuscitative ACC for severe torso trauma although some indication bias could still remain. Further studies are needed to elucidate optimal indications.

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Section: Introductionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta versus aortic cross clamping among patients with critical trauma: a nationwide cohort study in Japan

et al. 2016

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“…3), 56.1 mmHg in rAAA and 52.4 mmHg other types of patients in established hemorrhagic shock, among the 23 studies [10, 12, 22, 25, 29–31, 34, 36, 40, 41, 44, 45, 47, 48, 52, 55, 58, 59, 62, 66, 71, 97, 104, 105, 111] reporting pre-REBOA and post-REBOA SBP values.…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination

Burg

Dongen

Morrison

et al. 2018

Eur J Trauma Emerg Surg

134

102

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BackgroundCirculatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.MethodsSystematic review and meta-analysis (1900–2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords “aortic balloon occlusion”, “aortic balloon tamponade”, “REBOA”, and “Resuscitative Endovascular Balloon Occlusion” in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.ResultsA total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.ConclusionREBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.Electronic supplementary materialThe online version of this article (10.1007/s00068-018-0959-y) contains supplementary material, which is available to authorized users.

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“…REBOA was first reported to control hemorrhage including severe trauma in the 1950s. 6 Since then, REBOA has been used in multiple settings including massive gastrointestinal bleeding, 28 gynecologic emergencies, 29 and ruptured aortic aneurysms. 30,31 Recent clinical studies suggest a potential benefit of REBOA in the setting of critically uncontrolled hemorrhagic shock, 11,32 but these studies are relatively small and lack a control group to compare the efficacy of REBOA placement.…”

Section: Discussionmentioning

confidence: 99%

Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score‐adjusted untreated patients

Norii

Crandall²,

Terasaka³

2015

Journal of Trauma and Acute Care Surgery

192

135

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Balloon occlusion of the descending aorta in the treatment of severe post‐partum haemorrhage

Cited by 47 publications

References 14 publications

Resuscitative endovascular balloon occlusion of the aorta versus aortic cross clamping among patients with critical trauma: a nationwide cohort study in Japan

Resuscitative endovascular balloon occlusion of the aorta versus aortic cross clamping among patients with critical trauma: a nationwide cohort study in Japan

A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination

Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score‐adjusted untreated patients

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