Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock

Abstract

IntroductionIntra-aortic balloon occlusion (IABO) is useful for proximal vascular control, by clamping the descending aorta, in traumatic haemorrhagic shock. However, there are limited clinical studies regarding its effectiveness. This study aimed at investigating the effectiveness of IABO for traumatic haemorrhagic shock.MethodsThis retrospective, observational study included trauma patients who underwent IABO at the Emergency and Critical Care Center of Nippon Medical School Tama-Nagayama Hospital between January 2009 and March 2013. 14 patients were included to this study who were in shock on arrival (systolic blood pressure [SBP] <90 mmHg or shock index ≥1), underwent IABO for resuscitation and temporary haemostasis, and subsequently underwent haemostatic intervention (operation or transcatheter arterial embolization). Patient characteristics, physiological status, SBP, heart rate (HR), initial fluid and blood transfusion, time course, and total occlusion time were compared before and after IABO as well as between the survived (n = 5) and non-survived (n = 9) groups.ResultsThe majority of patients experienced blunt injuries, with an average injury severity score of 29.5. The liver, pelvis, spleen, and mesenterium represented the majority of injured organs. SBP, but not HR, was significantly higher after IABO than before IABO (123.1 vs. 65.5 mmHg, P = 0.0001). The revised trauma score and probability of survival were significantly different between the survived and non-survived groups (both, P = 0.04). The survived group required significantly less blood transfusion volume than the non-survived group (20 vs. 33.7 red blood cell units, P = 0.04). In addition, the survived group required a significantly shorter total occlusion time than the non-survived group (46.2 vs. 224.1 min, P = 0.002).ConclusionsIABO was used for relatively severe trauma patients. SBP was significantly higher after IABO, but was not related to survival. However, blood transfusion volume and total occlusion time were related to survival; therefore, it is important to reduce or shorten these parameters, i.e., immediate definitive haemostasis. IABO is effective for traumatic haemorrhagic shock; however, it is also important to consider these points and potential complications.

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

“…The main predictors of mortality in REBOA are the severity of injury and the duration of occlusion (16,20,31,34), which are not independent of each other. Patients in poor conditions are likely to present higher resuscitation requirements, being occluded earlier.…”

“…Numerous clinical and preclinical studies support the utility of REBOA in restoring hemodynamics in the context of hemorrhagic shock (15)(16)(17)(18)(19)(20)(21)(22). Nonetheless, physiological tolerance to aortic occlusion is related to the metabolic and vascular impact in the areas proximal and distal to the balloon.…”

“…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.…”

“…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.…”

Emergency vascular injuries: patient profile, management strategies and risk factors for mortality

“…[12,13] The major uses of endovascular techniques for trauma are bleeding control interventions such as balloon occlusion, embolization, and deployment of a covered stent, exclusion of pseudoaneurysms and arteriovenous fistulas by either covered stents or coil embolization, and deployment of bare metal stents or covered stents for dissection. [11,[14][15][16] In our daily practice, we have been using endovascular interventions increasingly for our elective cases; however, due to the lack of endovascular capabilities in the operating room, the number of emergency cases treated with this modality still remains low. In the present study, only one patient was treated with an endograft for ruptured subclavian artery, and one other patient underwent thoracic endovascular graft implantation, [17] although our number has been increasing since that time.…”