The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock

Morrison, Jonathan J.; Ross, James D.; Markov, Nickolay P.; Scott, Daniel; Spencer, Jerry R.; Rasmussen, Todd E.

doi:10.1016/j.jss.2014.04.012

Cited by 105 publications

(76 citation statements)

References 34 publications

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“…Consensus regarding safe occlusion times is not yet reached although animal studies indicate an optimal duration of 30 min. Occlusion time of 60 min or above is associated with an increased mortality [134, 135]. For prolonged field care or surgery, intermittent or partial occlusion could be a solution [71].…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination

Burg

Dongen

Morrison

et al. 2018

Eur J Trauma Emerg Surg

134

102

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BackgroundCirculatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.MethodsSystematic review and meta-analysis (1900–2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords “aortic balloon occlusion”, “aortic balloon tamponade”, “REBOA”, and “Resuscitative Endovascular Balloon Occlusion” in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.ResultsA total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.ConclusionREBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.Electronic supplementary materialThe online version of this article (10.1007/s00068-018-0959-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination

Burg

Dongen

Morrison

et al. 2018

Eur J Trauma Emerg Surg

134

102

View full text Add to dashboard Cite

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“…REBOA is highly dependent on a functional femoral artery access and its early establishment might be of considerable value [52, 70]. REBOA for pelvic bleeding in hemodynamic unstable patients has the advantage of being a minimal invasive procedure with less metabolic and surgical burden on the trauma patient but this is only based on expert opinion and animal experiments rather than firm data [66, 68, 71–74]. Its usage is though increasing dramatically worldwide, especially in the USA despite lack of high quality evidence and prospective trials and RCT data are needed.…”

Section: Methodsmentioning

confidence: 99%

Pelvic trauma: WSES classification and guidelines

et al. 2017

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Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

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“…After balloon deflation, its distribution throughout the circulatory system may thrust the Systemic Inflammatory Response Syndrome (SIRS), leading to increased resuscitation requirements and progression to Acute Respiratory Distress Syndrome (ARDS) (23). Hypoxia activates the anaerobic metabolism of the cells, thus increasing lactate levels and contributing to the lethal triad of hypothermia, acidosis and coagulopathy (17,14,25).…”

Section: Physiological Effects Of the Aortic Occlusion: Proximal And mentioning

confidence: 99%

“…There is good evidence from animal models that prolonged aortic occlusion of greater than 60 minutes will have a substantial systemic effect on cord perfusion and a poor outcome (17,21,23,25) Further work is, however, required to translate these finding into the clinical setting, but it appears that 40 minutes maybe an appropriate cut off time Systemic complications have been reported and include multisystem organ failure, acute kidney injury and ARDS (15,31). However, it is impossible to assess the contribution of REBOA and or trauma to the development of these complications.…”

Section: Outcomes Features and Keys For Successmentioning

confidence: 99%