Resuscitative endovascular balloon occlusion of the aorta for thoracic trauma: A translational swine study

Glaser, Jacob; Neidert, Leslie E.; Morgan, Clifford G; Brenner, Megan; Stigall, Kyle; Cardin, Sylvain

doi:10.1097/ta.0000000000002749

Cited by 13 publications

(17 citation statements)

References 17 publications

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“…There is concern about increasing bleeding due to increased blood pressure. A recent study that included three porcine models of thoracic trauma (lung injury, thoracic venous injury or subclavian artery injury) revealed that the use of REBOA does not aggravate lung damage or increases exsanguination rate 38 .…”

Section: Discussionmentioning

confidence: 99%

“…Existe preocupación por el incremento de la hemorragia en función del aumento de la presión arterial. Un estudio reciente que incluyó tres modelos porcinos de trauma torácico: lesión del parénquima pulmonar, lesión venosa torácica o lesión de la arteria subclavia reveló que el uso del REBOA no exacerba el daño pulmonar ni incrementa la tasa de exanguinación 38 .…”

Section: Discussionunclassified

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Damage control surgery in lung trauma

et al. 2021

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Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

Damage control surgery in lung trauma

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, data from animal models support the use of REBOA in penetrating thoracic trauma (41,42). For example, Glaser et al (42) assessed the hemodynamic response to REBOA in a swine model of hemorrhagic shock and penetrating thoracic injuries. After inflicting pulmonary parenchymal, thoracic venous, and subclavian artery injuries and treating them with and without REBOA, there were no significant differences in the total thoracic blood loss or short term survival between the REBOA and non-REBOA groups.…”

Section: Discussionmentioning

confidence: 99%

“…After inflicting pulmonary parenchymal, thoracic venous, and subclavian artery injuries and treating them with and without REBOA, there were no significant differences in the total thoracic blood loss or short term survival between the REBOA and non-REBOA groups. Therefore, there is preclinical data supported by clinical evidence (18,19,41,42) -though it is low quality evidence (case series/Level IV) -, to challenge the current recommendation that REBOA is contraindicated in patients with traumatic thoracic vascular injury and hemorrhage. However, clinical prudence is required when advocating REBOA as a therapeutic tool for these patients.…”

Section: Discussionmentioning

confidence: 99%

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Use of REBOA in the universe of magical realism: a real-world review

Manzano-Núñez

Chica-Yanten

Naranjo

et al. 2021

Colomb. J. Anesthesiol.

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While reading the novella “Chronicle of a Death Foretold” by the Colombian Nobel Laureate Gabriel García-Marquez, we were surprised to realize that the injuries sustained by the main character could have been successfully treated had he received modern trauma care in which REBOA may have been considered. This is a discussion of Mr. Nasar's murder to explore whether he could have been saved by deploying REBOA as a surgical adjunct to bleeding control and resuscitation. In reading García-Marquez's novel we noted the events that unfolded at the time of Santiago Nasar's murder. To contextualize the claim that Mr. Nasar could have survived, had his injuries been treated with REBOA, we explored and illustrated what could have done differently and why. On the day of his death, Mr. Nasar sustained multiple penetrating stab wounds. Although he received multiple stab wounds to his torso, the book describes seven potentially fatal injuries, resulting in hollow viscus, solid viscus, and major vascular injuries. We provided a practical description of the clinical and surgical management algorithm we would have followed in Mr. Nasar's case. This algorithm included the REBOA deployment for hemorrhage control and resuscitation. The use of REBOA as part of the surgical procedures performed could have saved Mr. Nasar's life. Based on our current knowledge about REBOA in trauma surgery, we claim that its use, coupled with appropriate surgical care for hemorrhage control, could have saved Santiago Nasar's life, and thus prevent a death foretold.

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