Resuscitative endovascular balloon occlusion of the aorta for uncontrollable nonvariceal upper gastrointestinal bleeding

Abstract

BackgroundAlthough resuscitative endovascular balloon occlusion of the aorta (REBOA) in various clinical settings was found to successfully elevate central blood pressure in hemorrhagic shock, this intervention is associated with high mortality and may represent a last-ditch option for trauma patients. We conducted a retrospective study of patients with nonvariceal upper gastrointestinal bleeding (UGIB) who underwent REBOA to identify the effectiveness of REBOA and reviewed published literatures.MethodsREBOA were performed by trained acute care physicians in the emergency room and intensive care unit. The deployment of balloon catheters was positioned using ultrasonography guidance. Collected data included clinical characteristics, hemorrhagic severity, blood cultures, metabolic values, blood transfusions, REBOA-related complications and mortality. A literature search using PUBMED to include “aortic occlusion” and “gastrointestinal bleeding” was conducted.ResultsREBOA was attempted in eight patients among 140 patients with UGIB and median age was 66 years. Systolic blood pressure significantly increased after REBOA (66 ± 20 vs. 117 ± 45 mmHg, p < 0.01) and the total occlusion time of REBOA was 80 ± 48 min. Strong positive correlations were found between total occlusion time of REBOA and lactate concentration (Spearman’s r=0.77), clinical Rockwall score (Spearman’s r=0.80), and age (Spearman’s r=0.88), respectively.ConclusionREBOA can be performed with a high degree of technical success and is effective at improving hemodynamic in patients with UGIB. Correlations between total occlusion time and high lactate levels, clinical Rockall score, and age may be important for successful use of REBOA.

Intra-aortic Balloon Occlusion for Acetabular Fractures: Concept and Proof

“…Use of intra-aortic balloon occlusion was shown in this investigation to decrease blood loss, allowing the surgeons to work in a less bloody surgical field and complete the procedure in a reasonable amount of time. They make note of the need to let the balloon down to allow reperfusion, and this correlates with existing data that found increased lactate and complication rates with prolonged occlusion times [2]. Reinflation of the balloon appears to be safe upon anecdotal recommendations, including this investigation, but more information is needed to provide optimal timing suggestions regarding reinflation.…”

“…Use of intra-aortic balloon occlusion via endovascular techniques was designed for resuscitative use in trauma patients and has been shown to be effective in reducing hemorrhagic shock mortality [1][2][3]. Use of this device for pelvic and acetabular fractures has been described in the literature to some success, as well as with complex hip and knee revision arthroplasties [4,5].…”

Indicações e resultados para o uso expandido da oclusão ressuscitativa por balão endovascular da aorta - REBOA.

“…We grouped the articles according to indication, into patients with non-traumatic abdominal hemorrhages, which were mostly case reports, the main indications being gastrointestinal bleeding, aneurism, iatrogenic bleeding and bleeding of unknown origin (Table 1) [16][17][18][19][20][21][22] . Another indication was for postpartum hemorrhage (Table 2) 20,23-28 .…”

“…Among the studies described, the main benefits of REBOA use were hemorrhage control and elevation of arterial pressure, reducing blood transfusion requirements and allowing patients to reach definitive treatment of injuries [16][17][18][19][20][22][23][24]26,27,29 . We carried out the analysis of this study in a segmented way, considering two large groups:…”

Intra-Aortic Balloon Occlusion for Pelvic and Sacrum Tumors: A Case Series

“…IABO has been described for successful temporary hemostasis for severe active bleeding, such as ruptured abdominal aortic aneurysm (2,3), abdominal trauma (4), gastrointestinal bleeding (5), postpartum hemorrhage (6) and pelvic fractures (7). In 2005, Mi C et al (8) applied the technique in upper sacral tumors, and gained satisfying effectiveness.…”