Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

Abstract

BackgroundSevere postpartum hemorrhage occurs in 1/1000 women giving birth. This condition is often dramatic and may be life threatening. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has in recent years been introduced as a novel treatment for hemorrhagic shock. We present a series of fluoroscopy-free REBOA for controlling life threatening postpartum hemorrhage.MethodsIn 2008 an ‘aortic occlusion kit’ was assembled and used in three Norwegian university hospitals. The on-call interventional radiologist (IR) was to be contacted with a response time < 30 minutes in case of life threatening PPH. Demographics and characteristics were noted from the medical records.ResultsThis retrospective study includes 36 patients treated with fluoroscopy-free REBOA for controlling severe postpartum hemorrhage in the years 2008–2015. The REBOA success rate was 100% and no patients died from REBOA related complications. Uterine artery embolization was performed in 17 (47%) patients and a hysterectomy in 16 (44%) patients. A short (11cm) introducer length was strongly associated with iliac artery thrombus formation (ρ = 0.50, P = 0.002). In addition, there was a strong negative correlation between uterine artery embolization and hysterectomy (ρ = -0.50, P = 0.002).ConclusionsOur Norwegian experience indicates the clinical safety and feasibility of REBOA in life threatening PPH. Also, REBOA can be used in an emergency situation without the use of fluoroscopy with a high degree of technical success. It is important that safety implementation of REBOA is established, especially through limited aortic balloon occlusion time and a thorough balloon deflation regime.

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

“…Even if the surgeon still has to be able to deal with potential complications, like ongoing bleeding from the puncture point, false aneurysm, artery dissection, thrombo-embolism, or limb-threatening ischemia, the use of this 7-French sheath facilitates the use of REBOA in less technical environments. Moreover, as shown previously by Stensaeth et al [ 22 ], it is possible to use this REBOA catheter without fluoroscopy. Another specific feature of this catheter, which makes it particularly suitable for use in an austere pre-hospital environment, is its self-guiding property in the aorta with its atraumatic tip, hence avoiding the need for a guide wire.…”

Resuscitative endovascular balloon occlusion of the aorta deployed by acute care surgeons in patients with morbidly adherent placenta: a feasible solution for two lives in peril

“…Neither massive transfusion nor admission to the intensive care unit was required, and the patient was discharged 1 week after C-section without any complications [ 23 ]. Since that initial case report, additional single cases [ 24 , 25 ] and uncontrolled case series [ 10 , 26 , 27 ] of MAP patients undergoing C-section combined with temporary aortic balloon occlusion were published. In these reports, REBOA was used either as a rescue maneuver to stop the bleeding during an emergency peripartum hysterectomy [ 10 , 24 , 25 ] or as a prophylactic hemodynamic adjunct in elective cases [ 26 , 27 ].…”

Indicações e resultados para o uso expandido da oclusão ressuscitativa por balão endovascular da aorta - REBOA.

“…Among the studies described, the main benefits of REBOA use were hemorrhage control and elevation of arterial pressure, reducing blood transfusion requirements and allowing patients to reach definitive treatment of injuries [16][17][18][19][20][22][23][24]26,27,29 . We carried out the analysis of this study in a segmented way, considering two large groups:…”

“…It was also used to control hemorrhagic shock in pregnant women with MAP (n=4) and control postpartum hemorrhage (n=36) [23][24][25]27 . REBOA was effective in the stabilization of bleeding and in the elevation of systolic arterial pressure 23,24,26,27 . reported thrombotic occlusion of the femoral artery.…”