Resuscitative endovascular balloon occlusion of the aorta for life-threatening postpartum hemorrhage: A nationwide observational study in Japan

Abstract

BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used for postpartum hemorrhage (PPH), which is one of the leading causes of maternal mortality worldwide; however, its utility in the obstetrics setting remains unclear. Thus, this study aimed to describe the characteristics, demographics, and mortality of patients with PPH who underwent REBOA. METHODS:We used the Japanese Diagnosis Procedure Combination inpatient database to identify patients with PPH who underwent REBOA from April 2012 to March 2020. We examined the patients' characteristics, interventions administered, and in-hospital mortality. RESULTS:We identified 143 patients with PPH who underwent REBOA. The most common cause of PPH was atonic postpartum hemorrhage (52.4%), followed by disseminated intravascular coagulation (29.4%) and amniotic fluid embolism documented (11.2%). Among patients who delivered at hospitals in which REBOA was performed (n = 55), 38.2% of patients experienced preterm births, and 70.9% delivered via cesarean delivery. The proportion of patients who underwent transcatheter arterial embolization and hysterectomy was 53.8% and 16.1%, respectively. In-hospital mortality was 7.0%. CONCLUSION:The results of the present study could be helpful in clinical decision making and providing patients and families with additional treatment options for PPH. (

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as adjunct treatment in life threatening postpartum hemorrhage: Fourteen years' experience from a single Norwegian center

“…In addition, REBOA is increasingly used for placenta accreta spectrum disorders, 10 which also includes our institution. Recently a large observational study from Japan was published, 11 in addition to several previous case reports. 12,13 In 2017, Nyfløt et al observed that the frequency of severe PPH (defined as blood loss ≥1500 mL) was 2.5% in three Norwegian University Hospitals, 14 the most common etiologies were uterine atony (60%) and placental complications (36%).…”

“…In addition, REBOA is increasingly used for placenta accreta spectrum disorders, 10 which also includes our institution. Recently a large observational study from Japan was published, 11 in addition to several previous case reports. 12 , 13 In 2017, Nyfløt et al.…”

Resuscitative Endovascular Balloon Occlusion of the Aorta is Associated with Increased Risk of Extremity Compartment Syndrome

“…Although the concept can be traced back to the Korean war [3], this specific technique reemerged and became popular in the past two decades [4,5]. Despite the questionable survival benefits, REBOA is currently being used not only for trauma, but also for other causes of abdominal bleeding, such as ruptured aortic aneurysm, post-partum hemorrhage, and gastrointestinal bleeding [6][7][8][9].…”

Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy are associated with similar outcomes in traumatic cardiac arrest

“…4,9 Catheter-based aortic occlusion has also been successfully applied to nontraumatic hemorrhage. [10][11][12] Although these results are encouraging, the exact role of REBOA within a trauma algorithm remains undefined, and current guidelines only recommend its use in hemodynamically unstable patients with pelvic injuries. 13 Likewise, the role of REBOA in traumatic cardiac arrest remains undefined.…”

“…Observational studies of REBOA have shown associations with improved survival in patients with traumatic hemorrhage, particularly those with pelvic hemorrhage, although these benefits are not demonstrated consistently, and there are no randomized controlled trials to inform its use 4,9 . Catheter-based aortic occlusion has also been successfully applied to nontraumatic hemorrhage 10–12 . Although these results are encouraging, the exact role of REBOA within a trauma algorithm remains undefined, and current guidelines only recommend its use in hemodynamically unstable patients with pelvic injuries 13 …”