Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

Brenner, Megan; Bulger, Eileen M.; Perina, Debra G.; Henry, Sharon M.; Kang, Christopher; Rotondo, Michael F.; Chang, Michael; Weireter, Leonard J.; Coburn, Michael; Winchell, Robert J.; Stewart, Ronald M.

doi:10.1136/tsaco-2017-000154

Cited by 161 publications

(163 citation statements)

References 12 publications

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“…It also recommends against transportation of patients with a REBOA in place, given the difficulty in management of the device, particularly in the context of failure or prolonged transport time. 11 Ongoing discussions by US Military Joint Trauma System Committee on Tactical Combat Causality Care have allowed for REBOA placement in select cases in the austere deployed setting, as described in the most recently published Joint Trauma System Clinical Practice Guidelines. 12 Placement at the point of injury has been suggested, especially in scenarios where the likelihood that survival to the next level of care is untenable without such an intervention.…”

Section: Discussionmentioning

confidence: 99%

“…13 In the deployed or austere setting, transfer of patients with a REBOA in place might be feasible as long as a capable trauma or vascular surgeon is available for troubleshooting and imminent definitive surgery. 11 Although the prehospital REBOA has been suggested for rural civilian settings, particularly in Europe, 14,15 to date it has been used primarily by the US military through highly specialized medical teams that employ REBOAtrained physicians, such as the Air Force Special Operations Surgical Team. Manley and colleagues 16 and Northern and colleagues 8 described successful lifesaving placement of the REBOA by Special Operations Surgical Team in 4 and 20 service members, respectively, who were all 2 to 3 hours from the nearest Role 2 facility.…”

Section: Discussionmentioning

confidence: 99%

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Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study

Henry¹,

Matsushima²,

Henry³

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used as part of damage control resuscitation for patients with non-compressible truncal hemorrhage. We hypothesized that there might be a select group of patients that could have benefited from prehospital placement of the REBOA. STUDY DESIGN: This was a retrospective cohort study including patients who presented to a Level I trauma center with cardiac arrest between January 2014 and March 2018. The findings of a full autopsy were reviewed for the details of internal injuries. A patient was determined to be a REBOA candidate if the patient sustained abdominal organ injuries or pelvic fractures and no associated severe head injuries. The candidate group was compared with the non-candidate group based on prehospital vital signs and other patient characteristics. A multiple logistic regression analysis was performed to identify certain prehospital factors associated with candidacy for prehospital REBOA. RESULTS:A total of 198 patients met our inclusion criteria. Of those, 27 (13.6%) patients were deemed REBOA candidates. Median Injury Severity Score was 22 (interquartile range 17 to 29). Patients in the candidate group were more likely to have a Glasgow Coma Scale score 9 (48% vs 15%; p ¼ 0.012), oxygen saturation >90% (56% vs 35%; p ¼ 0.03), and systolic blood pressure <90 mmHg (48% vs 26%; p ¼ 0.04) in the field. Logistic regression showed that these 3 clinical parameters of prehospital vital signs were significantly associated with REBOA candidacy. CONCLUSIONS: Our data suggest that >10% of trauma patients who presented with cardiac arrest could have benefited from prehospital REBOA. Additional prospective studies are warranted to validate the use of field vital signs in selecting candidates. (J Am Coll Surg 2019;229:383e388.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study

Henry¹,

Matsushima²,

Henry³

et al. 2019

Journal of the American College of Surgeons

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“…Any suspected thoracic injury is a contraindication for the use of endovascular balloon therapy . In addition, recent joint statements American College of Surgeons Committee on Trauma and the American College of Emergency Physicians have recommended that EM physicians without critical care training should not perform REBOA . At this time there does not appear to be an alternative for the patient suffering from traumatic arrest with suspected thoracic injuries amenable to an EDT.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Thoracotomy: Development of a Reliable, Validated Checklist for Procedural Training

Zaïdi

Dhake

Miller

et al. 2019

AEM Education and Training

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Objectives: Emergency department thoracotomy (EDT) is a rare and challenging procedure. Emergency medicine (EM) residents have limited opportunities to perform the procedure in clinical or educational settings. Standardized, reliable, validated checklists do not exist to evaluate procedural competency. The objectives of this project were twofold: 1) to develop a checklist containing the critical actions for performing an EDT that can be used for future procedural skills training and 2) to evaluate the reliability and validity of the checklist for performing EDT.Methods: After a literature review, a preliminary 22-item checklist was developed and disseminated to experts in EM and trauma surgery. A modified Delphi method was used to revise the checklist. To assess usability of the checklist, EM and trauma surgery faculty and residents were evaluated performing an EDT while inter-rater reliability was calculated with Cohen's kappa. A Student's t-test was used to compare the performance of participants who had or had not performed a thoracotomy in clinical practice. Item-total correlation was calculated for each checklist item to determine discriminatory ability.Results: A final 22-item checklist was developed for EDT. The overall inter-rater reliability was strong (j = 0.84) with individual item agreement ranging from moderate to strong (j = 0.61 to 1.00). Experts (attending physicians and senior residents) performed well on the checklist, achieving an average score of 80% on the checklist. Participants who had performed EDT in clinical practice performed significantly better than those that had not, achieving an average of 80.7% items completed versus 52.3% (p < 0.05). Seventeen of 22 items had an itemtotal correlation greater than 0.2. Conclusions:A final 22-item consensus-based checklist was developed for the EDT. Overall inter-rater reliability was strong. This checklist can be used in future studies to serve as a foundation for curriculum development around this important procedure.

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“…A meta‐analysis of REBOA and another of REBOA and open aortic cross clamping together with an early REBOA registry report all suggested positive effects on outcomes and are broadly supportive. There followed a statement from the American College of Surgeons highlighting indications, guidelines and complications. This statement has been recently updated and offers an excellent synopsis of key issues when considering utilisation of REBOA .…”

Section: Competing Interestsmentioning

confidence: 99%

REBOA: Where are we now?

Ellis

2020

Emerg Medicine Australasia

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Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

Cited by 161 publications

References 12 publications

Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study

Who Would Have Benefited from the Prehospital Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)? An Autopsy Study

Emergency Department Thoracotomy: Development of a Reliable, Validated Checklist for Procedural Training

REBOA: Where are we now?

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