Feasibility of REBOA—Resuscitative Endovascular Balloon Occlusion of the Aorta—in Trauma-Related Noncompressible Torso Hemorrhage at Two Metropolitan Trauma Centers

Abstract

Noncompressible torso hemorrhage (NCTH) involving the thoracic, abdominal, and pelvic regions from both blunt and penetrating trauma is recognized as a major cause of potentially preventable death. These patients have injuries not amenable to standard hemorrhage control techniques (tourniquets, wound packing, manual compression) and are at high risk of exsanguinating before undergoing definitive management in the operating theater or the interventional radiology suite. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive early management strategy that may provide temporary hemorrhage control in hemodynamically unwell patients with torso hemorrhage and bridge to definitive hemostasis.

The Colombian Experience in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): The Progression From a Large Caliber to a Low-Profile Device at a Level I Trauma Center

“…This is, so far, the largest experience with REBOA in Latin-America. The implementation of an institutional protocol for REBOA facilitated the deployment of REBOA in the OR, in fact, only two (4%) patients received it in the ED, contrary to what is commonly found in another series where the main location for REBOA deployment is the ED (8,9). Also, the main indication accepted worldwide is blunt trauma, despite this, 68% of our patients presented with penetrating trauma, compared with series reporting only 7% to 15% of the patients presenting with this trauma mechanism (9,10).…”

“…As REBOA has been indicated in patients with severe hemodynamic status (11), these patients were all hypotensive with a mean SBP of 70 mm Hg ± 30 and presented with a severe ISS (median of 25, IQR 25–41). Another striking finding was that 46% of the patients had thoracic injuries with only 23% of the patients having abdominal trauma, contrasting with US series where the predominant indications for REBOA are abdominal and pelvic hemorrhage (8, 9). These patients with thoracic trauma had favorable outcomes, with no differences in mortality with patients with abdominal or pelvic trauma, and no differences between in-hospital mortality and the predicted survival rate, our experience with chest trauma is described elsewhere (12).…”

REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

“…All REBOA catheters were placed by the attending trauma surgeon and the arterial access was obtained via a cutdown technique utilizing anatomical landmarks in most cases. Another striking difference is that most of our REBOA's are placed in the operating room (94%) and not in the emergency room, which is the norm worldwide 23,24 . All of our REBOA's are inflated initially in Zone 1 of the aorta and subsequently lowered to Zone 3 when indicated.…”

“…But with the introduction of the newly designed 7 Fr catheters, these vascular access complications have resolved. Their use is our recommendation at any center that is contemplating the adoption of this technology 24,26,27 .…”

Hybrid use of REBOA in a South African tertiary trauma unit for penetrating torso trauma

“…During the laparotomy performed in our case, a subxiphoid window was performed concurrently, followed by placement of bilateral tube thoracostomy. Once the above concerns were excluded, a sequential examination of the abdomen could take place 5 6. Besides direct proximal arterial control, REBOA offers the option of intermittent or partial aortic occlusion and an arterial line for sampling and invasive blood pressure monitoring.…”