The Colombian Experience in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): The Progression From a Large Caliber to a Low-Profile Device at a Level I Trauma Center

Abstract

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is now performed in many trauma centers, it is used at more than 250 hospitals in the United States and there is an increase rate of publications with the experience in these centers, but there is a gap of knowledge regarding the use of REBOA in Latin-America. This paper endeavors to describe the utilization of REBOA at a high level Latin-American Trauma Center and the transition from a large caliber to a low-profile device with the concomitant reduction in the groin access complications. Methods: A prospective, observational, single-center study was conducted. We included all trauma patients who underwent REBOA. We recorded data from admission parameters, complications, and clinical outcomes. Results: Fifty patients were included. Most of the REBOA catheters were inserted in the operating room [47 (94%)], and the arterial access was done by surgical cutdown [40 (80%)]. All the complications were associated with the catheter of 11 Fr Sheath used in 36 patients [n ¼ 8/36 (22%) vs. n ¼ 0/ 14 (0%); P ¼ 0.05]. Conclusion: REBOA can be used safely in blunt or penetrating thoracic, abdominal, and pelvic trauma. The insertion of a 7 Fr Sheath was associated with lower complications, so its use should be preferred over larger calibers.

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

“…Blindly occluding the aorta without access to proximal hemorrhage may not be beneficial. In contrast to current recommendations, recent case series from our institution (18,19,21), describing the feasibility and potential utility of deploying REBOA in these scenarios, found no significant differences between the true and the predicted survival rates of hemodynamically unstable patients with penetrating chest injuries and treated with REBOA (19).…”

“…The choice of REBOA over resuscitative thoracotomy rests on the knowledge that REBOA may improve the survival of exsanguinating patients with impending hemodynamic collapse, compared to RT. (9,20) We believe that the use of REBOA in the cases described above is supported by previous studies showing that this intervention may be safely used in penetrating thoracic, abdominal, and pelvic trauma (19,21). Moreover, lowerrisk adjusted odds of mortality have been reported when REBOA is deployed for penetrating trauma.…”

A Life Saving Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) with Open Groin Technique

“…Despite relatively lengthy procedures and requiring external compression on removal were noted. 18,19 Another difference in the open groin technique is that it is necessary to repair the common femoral artery and the groin incision. Nevertheless, this step should be done after the major operation, and the patient's hemodynamic is stable.…”

Buscando el punto crítico de presión arterial sistólica para la oclusión endovascular de la aorta: Análisis mundial de los registros REBOA

“…Respecto al trauma cerrado, la distribución de la mortalidad tiene un ascenso aproximado para valores de PAS previa al REBOA menores a 70 mmHg y por encima de 100 mmHg. La PAS previa a la inserción del REBOA en que la mortalidad [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]8).…”

“…Adicionalmente, esta cifra se asocia con una alta sensibilidad, pero regular especificidad en la predicción de mortalidad a las 24 horas, con un aumento en el numero de falsos positivos que potencialmente podría detectar, beneficiándolos con el uso de REBOA. Aunque la PAS tiene una moderada capacidad para predecir la mortalidad, esta debería complementarse con otros factores, como la respuesta o no a las maniobras de resucitación 6,21 .…”