Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

Abstract

Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

Complications associated with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA): an updated review

“… 49 The compliance of first-generation catheter balloons, like the Eliason-Rasmussen REBOA (ER-REBOA), limits control during deflation, leading to an all-or-nothing approach. 16 35 Challenges also arise from difficulty in predicting optimal balloon volume for transition from complete to partial occlusion and the unpredictable interaction of fully compliant balloons with the aortic wall. 48 50 51 …”

Resuscitative endovascular balloon occlusion of aorta (REBOA): expanding the window of survival in massive bleeding

“…While its use has been described in trauma and vascular surgery, it also has a major role in non-traumatic bleeding and resuscitation as part of the EVTM concept [6], with indications and contraindications for its use continuing to evolve. Existing evidence from case reports, animal and cohort studies suggest its use in both blunt or penetrating trauma; gastrointestinal (GI), obstetric-and gynaecologyderived bleeding events; visceral aneurysm rupture; thoracic and abdominal aortic aneurysm rupture; post-abdominal surgery; iatrogenic injuries; and, potentially, in both traumatic and non-traumatic cardiac arrest [6,9]. The lack of level 1 evidence such as randomized controlled trials, however, prevent consensus.…”

“…The suggested use of REBOA has been mainly in-hospital [5,6,12]; however, pre-hospital use has been reported in around 60 known cases in military and selected civilian reports [13] as well as in some unpublished data. The prehospital use of zone I (descending thoracic aorta) occlusion with REBOA has previously been controversial, especially in the case of thoracic trauma.…”

“…This concept does not replace traditional surgery but instead incorporates all available tools into a common trunk. These tools and REBOA are just one of them, maybe used in both traumatic and non-traumatic causes of hemodynamic instability and can also be used in pre-hospital or austere environments with limited resources to focus medical resources and attention on the appropriate needs of the patient [6].…”

Hemodynamic Effect of Resuscitative Endovascular Balloon Occlusion of the Aorta in Hemodynamic Instability Secondary to Acute Cardiac Tamponade in a Porcine Model

“…Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is gaining increasing popularity for use in obtaining temporary proximal hemorrhage control and temporary hemodynamic stability, whilst maintaining cerebral and myocardial perfusion (1)(2)(3)(4). According to the concept of EndoVascular resuscitation and Trauma Management (EVTM), the suggested use of REBOA has been mainly in-hospital (5)(6)(7)(8); however, pre-hospital use has been reported in around 60 known cases in military and selected civilian reports (9)(10)(11). The pre-hospital use of zone 1 (descending thoracic aorta) occlusion with REBOA (2) has previously been controversial, especially in the case of thoracic trauma (12).…”