Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta

Abstract

Therapeutic study, level V.

Resuscitative endovascular balloon occlusion of the aorta (REBOA): What have we learned?

“…The inherent limitations of animal trials highlight the need for further clinical investigations to assess these concerns. Several methods have been developed to mitigate these effects including intermittent balloon deflation (27); Others, being still laboratory focused consist of partial occlusion of the aorta (22) and establishment of an arterial shunt from above to below the balloon (28).…”

“…Survival rates of trauma patients undergoing REBOA from available studies (USA, Japan and Europe) range from 13% to 67% (14)(15)(16)18,20,27,(29)(30)(31)(32)(33)(34). Unfortunately, there are huge discrepancies in methodology, inclusion criteria and interventions.…”

Partial Zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in Management of Multiple Trauma with Combined Abdominal and Pelvic Injury

“…Partial inflation with controlled hypotensive target allowed benefits overcome risks of a defective procedure. REBOA adoption, even in a potentially dangerous position, gave authors time to move patient from OR to angiographic room (not available at the moment in our hospital a hybrid surgical angiographic suite) [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and time to find the primary source in a severe and multiple hemorrhagic trauma, with good clinical outcome.…”

The future of resuscitative endovascular balloon occlusion in combat operations

“…In the Japanese system, emergency physicians can be credentialed after performing REBOA three times during residency training 16. A REBOA patient may have their device placed by an emergency medicine physician and definitive treatment provided by interventional radiology without direct involvement of a surgeon 17. Prospective data from the Japan Trauma Data Bank was used to match REBOA patients to propensity score-adjusted non-REBOA patients and they found that patients who received REBOA were three times more likely to die than patients with similar severity of injuries who did not receive REBOA 16.…”