Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma

Abstract

Therapeutic study, level III.

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

“…Morphometric studies have proven the association of external corporal measurements, and other parameters, with the depth of insertion needed to deploy the balloon at the target site (32,33) This supports the feasibility of an accurate deploy of the balloon by the only means of physical exam. Most studies do not to use any imaging (16,18,20,31,34) and as such does not require either a vascular surgeon or interventional radiologist.…”

“…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.…”

“…Additionally, the dramatic improvement of hemodynamics may bring about a false sense of security that sets back decision-making and leads to unnecessary further examinations. Several authors have raised concerns about safety of REBOA (32,33), showing an increased mortality with the use of this tool. Maybe the poor prognosis that they found is the product of a non-ideal scenario.…”

Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan

“…In addition, there is no nationally standardised certification and therefore, endovascular workshops15 16 were conducted to provide qualifying skills. The Japanese Society of DIRECT (established in 2011)9 has been conducting workshops since 2013 to promote safe insertion procedures in the ED without fluoroscopy for EM physicians, acute care surgeons and IRs.…”

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.…”