Field and en route resuscitative endovascular occlusion of the aorta

Reva, Viktor; Hörer, Tal M.; Makhnovskiy, A. I.; Sokhranov, M V; Samokhvalov, I.M.; DuBose, Joseph J.

doi:10.1097/ta.0000000000001476

Cited by 38 publications

(22 citation statements)

References 26 publications

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“…Second, because the surgeon is focused on his surgery during DCS, would it not then be better to let the anesthetist inflate and deflate the balloon of the REBOA and follow adequately the inflation time? Third, because pREBOA in a dynamic approach is an adjunct for resuscitation, would it then be helpful to use REBOA during transport between two MTF as suggested by Reva [ 44 ]? For such a usage, more people in the whole chain of evacuation, also from the transport team, would definitely need to comprehend this relatively new paradigm and to be confident with the material.…”

Section: Discussionmentioning

confidence: 99%

Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects

et al. 2018

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BackgroundThe present paper describes three cases where ER-REBOA® was used with partial aorta occlusion (AO), by performing a partial resuscitative endovascular balloon occlusion of the aorta or pREBOA, in an austere pre-hospital military environment.In addition, because no specific REBOA algorithm for pre-hospital environment exists yet, this paper seeks to fill this gap, proposing a new pragmatic REBOA algorithm.MethodsBelgian Special Operations Surgical Team applied REBOA in three patients according to a decisional algorithm, based on the MIST acronym used for trauma patients. Only 3 ml, in the first instance, was inflated in the balloon to get AO. The balloon was then progressively deflated, and reperfusion was tracked through changes of end-tidal carbon dioxide (EtCO2).ResultsSystolic blood pressure (SBP) before ER-REBOA® placement was not higher than 60 mmHg. However, within the first 5 min after AO, SBP improved in all three cases. Due to the aortic compliance, a self-made pREBOA was progressively achieved while proximal SBP was raising with intravenous fluid infusion. Afterwards, during deflation, a steep inflection point was observed in SBP and EtCO2.ConclusionsER-REBOA® is suitable for use in an austere pre-hospital environment. The MIST acronym can be helpful to select the patients for which it could be beneficial. REBOA can also be performed with pREBOA in a dynamic approach, inflating only 3 mL in the balloon and using the aortic compliance. Furthermore, while proximal SBP can be convenient to follow the occlusion, EtCO2 can be seen as an easy and interesting marker to follow the reperfusion.

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Section: Discussionmentioning

confidence: 99%

Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects

et al. 2018

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“…Furthermore, the pioneering use of this hemorrhage control adjunct in the prehospital phase, despite early promising results [ 15 , 16 ], has not been widely adopted. Recent terrorist threats in western countries have contributed to an increased awareness of the value for bleeding control in the earliest phases after injury, suggesting that the potential utilization of this REBOA in this setting warrants examination [ 17 ].…”

Section: Introductionmentioning

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 has been used successfully in emergency rooms with or without fluoroscopy support, in any retroperitoneal zones (I, II or III). REBOA has already been used in the war field and has become promising for use in the pre-hospital environment [77][78][79][80]. Indeed, REBOA may play an important role in the prehospital management of severe pelvic injuries, with the balloon at the level of the aortic bifurcation, aiding in the control of catastrophic pelvic bleeding [79,80].…”

Section: Bleeding Control In the Pre-hospital Setting -Current Statusmentioning

confidence: 99%

Pre-hospital environment bleeding: from history to future prospects

Pereira

Dorigatti²,

Calderón³

et al. 2019

ait

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While the blood was related to life since antiquity, scientific investigations on anatomy and physio logy of the circulation system had to wait until the arrival of the 16 th century. In trauma patients, hemorrhagic shock is the main risk factor for multiple organ dysfunction and consequent increased mortality. On the pre-hospital setting intravenous administration of crystalloid solution became the more common intervention during resuscitation of trauma patient due to many reasons although currently new discussions have blossomed on regards type of fluids and resuscitation. The object of this manuscript is to review the history of pre-hospital care bleeding management and to gather new perspectives for the future. Herein authors discuss several issues on bleeding control: 1. Current status and future possibilities on stop the bleeding in the the pre-hospital setting-movements after the Hartford Consensus, use of topic homeostatic agents, tourniquets, REBOA and other radical interventions; 2. Damage control resuscitation in the pre-hospital environment-is massive transfusion protocol feasible at this setting? Tranexemic acid should be done? Possibilities that may improve survival and coagulopathy understanding; 3. Critical decision and decision making on stop the bleed; 4. Proposed flowchart on bleeding control. The implementation of measures to stop acute bleeding in the pre-hospital setting is a well-known and well-founded measure. However, the provision of current evidence demonstrates that these measures go far beyond compression and elevation of the limb as was known in the past. The deep understanding of the mechanism of coagulopathy and the new adjuvant arsenal to control bleeding are essential for a better quality of pre-hospital medical care as well as lower mortality rates.

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Field and en route resuscitative endovascular occlusion of the aorta

Cited by 38 publications

References 26 publications

Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects

Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects

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

Pre-hospital environment bleeding: from history to future prospects

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