“REBOA” – Is it Really Safe? A Case with Massive Intracranial Hemorrhage Possibly due to Endovascular Balloon Occlusion of the Aorta (REBOA)

Uchino, Haruto; Tamura, Nobuichiro; Echigoya, Ryosuke; Ikegami, Tetsunori; Fukuoka, Toshio

doi:10.12659/ajcr.900267

Cited by 79 publications

(53 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a head and pelvic injury case treated by REBOA, Uchino et al . reported that a complication developed in the site proximal to the occlusion by REBOA in which minor intracranial bleeding was seen in the head CT at the initial diagnosis, wherein the bleeding suddenly increased and a cerebral hernia developed and the patient died [3]. In this case, REBOA excessively raised the perfusion pressure in the chest area proximal to the occlusion, and coagulopathy occurred, induced by trauma shock and trauma itself.…”

Section: Discussionmentioning

confidence: 95%

“…However, complications developing around the site proximal to the occlusion, such as the possibility of increase in bleeding in the site proximal to the occlusion and the side effects of hyperperfusion, have hardly been studied to date. A systematic review [2] of REBOA, which included 61 articles and 1355 patients, showed that complications of the site proximal to the occlusion occurred only in one patient (0.07%) [3]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report

et al. 2017

View full text Add to dashboard Cite

BackgroundThe resuscitative endovascular balloon occlusion of the aorta, because of its efficacy and feasibility, has been widely used in treating patients with severe torso trauma. However, complications developing around the site proximal to the occlusion by resuscitative endovascular balloon occlusion of the aorta have almost never been studied.Case presentationA 50-year-old Japanese woman fell from a height of approximately 10 m. At initial arrival, her respiratory rate was 24 breaths/minute, her blood oxygen saturation was 95% under 10 L/minute oxygenation, her pulse rate was 90 beats per minute, and her blood pressure was 180/120 mmHg. Mild lung contusion, hemopneumothorax, unstable pelvic fracture, and retroperitoneal bleeding with extravasation of contrast media were observed in initial computed tomography. As her vital signs had deteriorated during computed tomography, a 7-French aortic occlusion catheter (RESCUE BALLOON®, Tokai Medical Products, Aichi, Japan) was inserted and inflated for aortic occlusion at the first lumbar vertebra level and transcatheter arterial embolization was performed for the pelvic fracture. Her bilateral internal iliac arteries were embolized with a gelatin sponge; however, the embolized sites presented recanalization as coagulopathy appeared. Her bilateral internal iliac arteries were re-embolized by n-butyl-2-cyanoacrylate. The balloon was deflated 18 minutes later. After embolization, repeat computed tomography was performed and a massive hemothorax, which had not been captured on arrival, had appeared in her left pleural cavity. Thoracotomy hemostasis was performed and a hemothorax of approximately 2500 ml was aspirated to search for the source of bleeding. However, clear active bleeding was not captured; resuscitative endovascular balloon occlusion of the aorta may have been the cause of the increased bleeding of the thoracic injury at the proximal site of the aorta occlusion.ConclusionsIt is necessary to note that the use of resuscitative endovascular balloon occlusion of the aorta may increase bleeding in sites proximal to occlusions, even in the case of minor injuries without active bleeding at the initial diagnosis.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Although not addressed by this study, the effects of REBOA on the brain are not well characterized and may be similarly negatively impacted. Although increases in proximal flow and pressure from REBOA may exacerbate intracranial hemorrhage,30 the change in arterial impedance and capacitance may also adversely affect a non-injured brain. Similar to the effects on the heart, cases of hypertensive emergency with abrupt significant increases in afterload have been reported to result in encephalopathy, transient ischemic attack, and stroke 31.…”

Section: Discussionmentioning

confidence: 99%

Extended resuscitative endovascular balloon occlusion of the aorta (REBOA)-induced type 2 myocardial ischemia: a time-dependent penalty

Wasicek¹,

Teeter²,

Yang

et al. 2019

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundResuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) increases cardiac-afterload and is used for patients in hemorrhagic shock. The cardiac tolerance of prolonged afterload augmentation in this context is unknown. The aim of this study is to quantify cardiac injury, if any, following 2, 3 and 4 hours of REBOA.MethodsAnesthetized swine (70–90 kg) underwent a 40% controlled hemorrhage, followed by supraceliac resuscitative endovascular balloon occlusion of the aorta (REBOA) for 2 (n=5), 3 (n=5), and 4 hours (n=5). High-fidelity arterial wave form data were collected, and signal processing techniques were used to extract key inflection points. The adjusted augmentation index (AIx@75; augmentation pressure/pulse pressure, normalized for heart rate) was derived for use as a measure of aortic compliance (higher ratio = less compliance). Endpoints consisted of electrocardiographic, biochemical, and histologic markers of myocardial injury/ischemia. Regression modeling was used to assess the trend against time.ResultsAll animals tolerated instrumentation, hemorrhage, and REBOA. The mean (±SD) systolic blood pressure (mm Hg) increased from 65±11 to 212±39 (p<0.001) during REBOA. The AIx@75 was significantly higher during REBOA than baseline, hemorrhage, and resuscitation phases (p<0.05). A time-dependent rise in troponin (R2=0.95; p<0.001) and T-wave deflection (R2=0.64; p<0.001) was observed. The maximum mean troponin (ng/mL) occurred at 4 hours (14.6±15.4) and maximum T-wave deflection (mm) at 65 minutes (3.0±1.8). All animals demonstrated histologic evidence of acute injury with increasing degrees of cellular myocardial injury.DiscussionProlonged REBOA may result in type 2 myocardial ischemia, which is time-dependent. This has important implications for patients where prolonged REBOA may be considered beneficial, and strategies to mitigate this effect require further investigation.Level of evidenceII.

show abstract

“…We lack consensus on the use of REBOA in patients with concomitant TBI. Animal data have demonstrated a significant increase in intracranial pressure during occlusion, and case reports have documented worsening cerebral hemorrhage following REBOA [21][22]. Opinions regarding the use of REBOA in a polytrauma patient with TBI is mixed, with half of the providers identifying TBI as a contraindication for REBOA use.…”

Section: Reboa Techniquesmentioning

confidence: 99%

Practice Preferences using Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Injury Before and After the 2017 EndoVascular and Hybrid Trauma and Bleeding Management Symposium

DeSoucy

Loja²,

Davidson³

et al. 2023

JEVTM

View full text Add to dashboard Cite

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to aid in resuscitative efforts for hemorrhagic shock. The use of REBOA is not yet commonplace and there is little understanding of real-world practice patterns. The Endovascular and Hybrid Trauma and Bleeding Management Symposium is a large international conference specifically developed to discuss multidisciplinary, endovascular and hybrid approaches to hemorrhage management. We sought to evaluate provider opinions and practice patterns using REBOA for traumatic vascular injury before and after attending this conference. Methods: A detailed survey was completed by a variety of providers before and after the conference. The survey was composed of demographic information, and focused on practice patterns and opinions regarding the implementation of REBOA. Results: We received 186 survey responses (99 pre, 87 post). There was increased perception of feasibility for REBOA in all settings, with the largest increase for pre-hospital and austere military environments (53.5% pre, 67.8% post and 59.6% pre, 73.6% post respectively). While there was no consensus on tolerable occlusion times and indications for utilization, most participants felt that partial REBOA was the most viable technique for prolonging the benefits of REBOA, and more participants came to this conclusion after attending the conference (62.2% pre, 81.6% post, p=0.006). Conclusions: REBOA is an exciting and important advancement in the management of life threatening hemorrhage, however its implementation has not been codified and there is much variation in practitioners’ understanding of its use. Continued investigation is needed to determine the appropriate indications, methods, and practical limitations of REBOA as a new hemorrhage management paradigm.

show abstract

“REBOA” – Is it Really Safe? A Case with Massive Intracranial Hemorrhage Possibly due to Endovascular Balloon Occlusion of the Aorta (REBOA)

Cited by 79 publications

References 10 publications

Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report

Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report

Extended resuscitative endovascular balloon occlusion of the aorta (REBOA)-induced type 2 myocardial ischemia: a time-dependent penalty

Practice Preferences using Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Injury Before and After the 2017 EndoVascular and Hybrid Trauma and Bleeding Management Symposium

Contact Info

Product

Resources

About