1. Algorithm for REBOA in hemorrhagic shock
Dong Hun Kim1, Seok Won Lee1, Ye Rim Chang1, Jeongseok Yun1, Seokho Choi1, Sung Wook Chang2, Jung-Ho Yun3
1Department of Trauma Surgery, 2Department of Thoracic and Cardiovascular Surgery, 3Department of Neurosurgery,
Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea
Resuscitative Endovascular Balloon Occlusion of the Aorta: A Single Trauma Center Experience in Korea
INTRODUCTION
Noncompressible torso hemorrhage (NCTH): Leading cause of potentially preventable trauma mortality
Patients with NCTH have very high-mortality rates and are at high risk of exsanguination before potentially life-saving surgical interventions can be performed.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) as minimally invasive alternative to open aortic cross clamping to provide temporary aortic occlusion can be a bridging modality for damage control resuscitation.
We present experiences of REBOA in patients with exsanguinating abdominal or pelvic injuries after multiple trauma in Korea.
Methods
Algorithm for REBOA in hemorrhagic shock
Case series
From August 2016 to September 2018, in which an institutional REBOA protocol was established at a level I trauma center
Subjects: Blunt trauma patients with abdominopelvic exsanguination and unstable hemodynamics (hypotension; SBP<90mmHg)
The data are presented as median (25th–75th percentile) for continuous variables or as absolute n (%) for categorical data
Methods
In general, the balloon ideally should be inflated within the maximal volume of the balloon catheter until hemorrhage control is achieved.
Balloon positioning: confirmed positioning with serial X-ray (portable)
ATLS, advanced trauma life support; SBP, systolic blood pressure; FAST, focused assessment with sonography for trauma; REBOA, resuscitative endovascular balloon occlusion of the aorta; *, early transfusion in resuscitation room; and no possible aortic injury by chest radiography; †, Door-to incision time less than 30 minutes
Results
Population characteristics
REBOA procedure
Post-REBOA clinical course
Comparison between survivors and non-survivors REBOA
Post-REBOA clinical course
SBP status during REBOA (p<0.001)
Before REBOA : 55 (47-60)
After REBOA: 99 (87-110)
Increase in SBP during REBOA
Total: 48 (32-57)
Zone I: 50 (IQR 25)
Zone III: 36 (IQR 21)
Conclusion
Procedure failure rate of REBOA: 6.5%
Overall survival rate in abdominopelvic trauma resuscitated with REBOA: 28.0%
REBOA might be a favorable resuscitative modality as a bridging procedure for definite bleeding control in blunt trauma patients, especially with exsanguination of a solitary abdominal organ.
Systemic treatment strategies for definitive bleeding control of severe multiple injuries, such as liver, pelvis or multiorgan injuries, would be needed for survival following REBOA.