The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest

Daley, James M.; Morrison, Jonathan J.; Sather, John; Hile, Lisa M.

doi:10.1016/j.ajem.2017.01.010

Cited by 81 publications

(64 citation statements)

References 55 publications

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“…4,5 Resuscitative endovascular balloon occlusion of the aorta represents a new tool that can be used as an alternative to performing resuscitative thoracotomy (RT) in traumatic arrest 6 ; as an adjunct for intra-abdominal, pelvic, or junctional hemorrhage 7 ; or as a method of promoting central perfusion in cases of circulatory collapse from non-hemorrhagic shock. 8 The American Association for the Surgery of Trauma (AAST) Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery (AORTA) multi-institutional database was created in 2013 as a means to capture contemporary methods of AO with the purpose of refining clinical protocols and future data collection. The results from this database demonstrated no difference in survival between REBOA and RT; however, the study included all patients who received REBOA with significantly varied causes of hemorrhage and physiologic status at the time of intervention.…”

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confidence: 99%

Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry

Brenner

Inaba

Aiolfi

et al. 2018

Journal of the American College of Surgeons

215

178

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confidence: 99%

Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry

Brenner

Inaba

Aiolfi

et al. 2018

Journal of the American College of Surgeons

215

178

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“…Two of the NDT group were hypotensive from neurogenic shock, and one patient was hypotensive from a suspected blunt cardiac injury. While most of the evidence regarding the safety and efficacy of REBOA is in hemorrhagic models, some studies suggest a benefit from increased coronary and cerebral perfusion in non-traumatic models [4]. This suggests that both neurogenic and blunt cardiogenic shock could potentially benefit from REBOA, and there is a lack of evidence to suggest REBOA would be unsafe in these patients.…”

Section: Discussionmentioning

confidence: 99%

Unstable Without a Source: The Non-Diagnostic Triad in Hypotensive Blunt Trauma Victims

Reily

Simpson

Evans³

et al. 2019

JEVTM

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Background: Current algorithms for resuscitation in blunt trauma patients rely on chest x-ray, FAST, and pelvic x-ray to quickly elicit a source of major bleeding in the trauma bay. There are currently no good recommendations for the patient in whom all three of these imaging studies are negative. Methods: We identified blunt trauma victims who presented with a systolic blood pressure below 100mmHg. Chest x-ray, FAST, and pelvic x-ray obtained in the trauma bay were reviewed, and patients who had all three studies negative underwent thorough chart review and characterization of injuries. Results: Of the total hypotensive blunt trauma victims (n=649), we found 47 who had a “non-diagnostic triad” (NDT). Of the NDT group, 31.9% (n=15) were found to have a major injury contributing to hypotension, while 61% (n=29) were not diagnosed with a severe injury that could have contributed to hypotension. Of the NDT group with severe injury, 40% (n=6) were found to have retroperitoneal bleeding, 40% (n=6) were found to have intraperitoneal bleeding despite negative fast, 13% (n=2) were thought to have spinal shock, and one patient had a blunt cardiac injury. Conclusions: Most of the NDT group patients in this study were not diagnosed with a serious injury. However, a significant minority (31%) were found to have a major injury contributing to hypotension. Of these patients, retroperitoneal and/or intra-abdominal bleeding were found in 80%, with neurogenic and cardiogenic shock less common. We feel these sicker NDT patients may benefit from REBOA, although more study is warranted before formal algorithms and recommendations are made.

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“…The possible control of bleeding and the hemodynamic effect of REBOA with improvement in coronary and cerebral perfusion pressure may have a positive survival benefit (9,10). On the other hand, REBOA serves as a bridge to definitive surgical bleeding control and treatment, and is therefore a procedure used to gain time and not for definitive care (11).…”

Section: Introductionmentioning

confidence: 99%

Pre-hospital CPR and early REBOA in trauma patients - Results from the ABOTrauma Registry.

Hilbert-Carius

McGreevy

Abu‐Zidan

et al. 2020

Preprint

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Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to hospital with ongoing CPR. Nine patients (35%) died within the first 24 hours, while seventeen patients (65%) survived post 24 hours. The survival rate to hospital discharge was 27% (n=7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p=0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. Survival rate in the 16 patients responding to REBOA was 37.5% (n=6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from median (range) 56.5 (0-147) to 90 (0-200) mmHg. Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated. Keywords: REBOA, Cardiac Arrest, Trauma, CPR, Endovascular Resuscitation.

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The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest

Cited by 81 publications

References 55 publications

Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry

Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma's Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry

Unstable Without a Source: The Non-Diagnostic Triad in Hypotensive Blunt Trauma Victims

Pre-hospital CPR and early REBOA in trauma patients - Results from the ABOTrauma Registry.

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