Successful Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in an Octogenarian Trauma Patient

Abstract

- Background: To demonstrate how to perform successful REBOA/ABO in extreme elderly patient
 - Materials and methods: A case report
 - Results:
 A 86-year old male, he was struck by car and transferred to Level I Trauma center at Siriraj hospital after injury for 30 minutes. Arrival clinical signs were coma and hypotension, lowest SBP was 50 mmHg. Primary survey found unstable pelvic fracture and severe head injury. We did REBOA at Zone I via left common femoral artery which aim to do partial balloon technique by inflation with 15-18 mL and arterial line monitoring for goal SBP around 100-120 mmHg due to his extreme age and associated traumatic brain injury. After CT scan showed no intra-abdominal injury, we did reposition the balloon to zone III under fluoroscopy. Unexpectedly, during deflation the balloon before removal, we found fresh blood through the balloon port, then ruptured balloon was suspected and confirmed with aortography. We immediately converted to remove by open technique due to balloon was failed to shrinkage through 7-Fr sheath. We reviewed the CT scan was shown calcified plaque along aorta and arteries which could be the cause of ruptured balloon. Throughout all procedures to stop bleeding which are pelvic external fixation, preperitoneal pelvic packing and embolization at right internal iliac artery, patient was given PRC only 4 units and no inotropic support to stabilizing patient. Total inflation time was 167 minutes with partial and intermittent REBOA technique. ICU Admission lab showed normal renal and liver function.
 - Conclusion :
 To perform ABO/REBOA in extreme elderly trauma patient, the partial balloon technique with goal SBP to balance between associated injury in polytrauma patient is very essential. The specific concern in this group would be related with reserve function and the changing of vascular access. Techniques for detection and solving the uneventful conditions should be prepared and learnt to successfully save the elderly patient.

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

“…However, when they isolate those patients treated for greater than 30 min, they find higher organ disfunction in the cREBOA patients. In addition to this retrospective study, there are a number of single patient reports and a case series in patients with trauma, 39,41,44,46,51,52 postpartum hemorrhage, 47 ectopic pregnancy, 50 ruptured aneurysm, 42 as well as a techniquefocused report that discusses use in patients with trauma without reporting patient-specific variables. 48 These reports include a variety of REBOA devices including the ER-REBOA catheter, 42,44,46e48,52 the Rescue Balloon (Tokai Medical Products, Japan).…”

“…48 These reports include a variety of REBOA devices including the ER-REBOA catheter, 42,44,46e48,52 the Rescue Balloon (Tokai Medical Products, Japan). 41 The clinical course of these patients is diverse, with some authors reporting multiple periods of partial REBOA and cREBOA, 41,51 and transition from zone 1 to zone 3, 41,47,51 and cardiopulmonary resuscitation before REBOA 39,46,51,52 and during subsequent surgical intervention. 42 These reports include some challenging clinical scenarios including religious objection to blood product resuscitation, 47 combined hemorrhage and TBI, 39,41 type-2 non-ST elevation myocardial infarction combined with trauma, 46 military casualties with an extended evacuation, 39,44 and a high-acuity penetrating trauma treated in a community hospital.…”

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

“…However, it is not possible to directly link the use of pREBOA to these positive outcomes given the retrospective nature of the reports. Other reports of clinical pREBOA use for trauma are limited to case series and case reports 30,66–68 . Military uses of pREBOA have been reported by the Belgian Special Operations team in three patients using the ER-REBOA catheter, with all patients surviving to evacuation after approximately 30 minutes of pREBOA 30 …”