Journal Article10.1016/j.surge.2023.08.001
International registry on aortic balloon occlusion in major trauma: Partial inflation does not improve outcomes in abdominal trauma
Maya Paran,David McGreevy,Tal M. Hörer,Mansoor Khan,Mickey Dudkiewicz,Boris Kessel,Mitra Sadeghi,Artai Pirouzram,Asko Toivola,Per Skoog,Koji Idoguchi,Yuri Kon,Toshiro Ishida,Yosuke Matsumura,Junichi Matsumoto,Mariusz Maszkowski,Adam Bersztel,Eva-Corina Caragounis,Till T. Bachmann,Mårten Falkenberg,Lauri Handolin,Stephanie W. Chang,Andrew C. Hecht,Dan Hebron,Gad Shaked,Miklosh Bala,Federico Coccolini,Luca Ansaloni,Rigo Hoencamp,Yunus Emre Özlüer,Peter Hilbert-Carius,Viktor Reva,George Oosthuizen,Endre Szarka,V Manchev,Tongporn Wannatoop,Carlos A. Ordóñez,Thomas Larzon,Kristofer F. Nilsson +38 more
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TL;DR: REBOA is feasible and has similar survival rates to laparotomy in patients with isolated abdominal injury. Post-balloon inflation SBP >80 mmHg is associated with lower 24-h mortality.
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Abstract: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method for temporary hemorrhage control used in haemodynamically unwell patients with severe bleeding. In haemodynamically unwell abdominal trauma patients, laparotomy remains the initial procedure of choice. Using REBOA in patients as a bridge to laparotomy is a novel option whose feasibility and efficacy remain unclear. We aimed to assess the clinical outcome in patients with abdominal injury who underwent both REBOA placement and laparotomy. This is a retrospective study, including trauma patients with an isolated abdominal injury who underwent both REBOA placement and laparotomy, during the period 2011–2019. All data were collected via the Aortic Balloon Occlusion Trauma Registry database. One hundred and three patients were included in this study. The main mechanism of trauma was blunt injury (62.1%) and the median injury severity score (ISS) was 33 (14–74). Renal failure and multi-organ dysfunction syndrome (MODS) occurred in 15.5% and 35% of patients, respectively. Overall, 30-day mortality was 50.5%. Post balloon inflation systolic blood pressure (SBP) >80 mmHg was associated with lower 24-h mortality (p = 0.007). No differences in mortality were found among patients who underwent partial occlusion vs. total occlusion of the aorta. Our results support the feasibility of REBOA use in patients with isolated abdominal injury, with survival rates similar to previous reports for haemodynamically unstable abdominal trauma patients. Post-balloon inflation SBP >80 mmHg was associated with a significant reduction in 24-h mortality rates, but not 30-day mortality. Total aortic occlusion was not associated with increased mortality, MODS, and complication rates compared with partial occlusion.
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Citations
Continuous renal replacement therapy with cytokine-adsorbing hemofilter to control resuscitative endovascular balloon occlusion of the aorta-related ischemia-reperfusion injury in a swine hemorrhagic shock model
Yosuke Hayashi,Yoshimitsu Izawa,Yasutaka Tanaka,Makoto Aoki,Yosuke Matsumura +4 more
- 30 May 2024
TL;DR: CRRT with cytokine-adsorbing hemofilter improves survival and controls metabolic acidosis, hyperkalemia, and hypercytokinemia in hemorrhagic shock with resuscitative endovascular balloon occlusion of the aorta.
REBOA in trauma: a life-saving intervention or a spectacular failure?
Bellal Joseph,Demetrios Demetriades +1 more
Is Occlusion the Solution? REBOA as a Hemorrhage Control Adjunct
Sarah Lee,Kaushik Mukherjee +1 more
TL;DR: This study reviews the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a hemorrhage control adjunct, highlighting its clinical applications, challenges, and potential complications, emphasizing the need for standardized training and multidisciplinary approach to optimize its use.
References
A National Evaluation of the Effect of Trauma-Center Care on Mortality
Ellen J. MacKenzie,Frederick P. Rivara,Gregory J. Jurkovich,Avery B. Nathens,Katherine Frey,Brian L. Egleston,David S. Salkever,Daniel O. Scharfstein +7 more
TL;DR: It is shown that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.
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Pelvic trauma: WSES classification and guidelines
Federico Coccolini,Philip F. Stahel,Giulia Montori,Walter L. Biffl,Tal M. Hörer,Fausto Catena,Yoram Kluger,Ernest E. Moore,Andrew B. Peitzman,Rao R. Ivatury,Raul Coimbra,Gustavo Pereira Fraga,Bruno Pereira,Sandro Rizoli,Andrew W. Kirkpatrick,Ari Leppäniemi,Roberto Manfredi,Stefano Magnone,Osvaldo Chiara,Leonardo Solaini,Marco Ceresoli,Niccolò Allievi,Catherine Arvieux,George C. Velmahos,Zsolt J. Balogh,Noel Naidoo,Dieter G. Weber,Fikri M. Abu-Zidan,Massimo Sartelli,Luca Ansaloni +29 more
TL;DR: The World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines are presented.
Preventable deaths from hemorrhage at a level I Canadian trauma center.
TL;DR: Hemorrhage from blunt pelvic injury was the major cause of exsanguination in 12 of 14 of these preventable deaths, suggesting blunt injury is the major mechanism leading to trauma deaths.
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Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta.
Nobuyuki Saito,Hisashi Matsumoto,Takanori Yagi,Yoshiaki Hara,Kazuyuki Hayashida,Tomokazu Motomura,Kazuki Mashiko,Hiroaki Iida,Hiroyuki Yokota,Yukiko Wagatsuma +9 more
TL;DR: REBOA seems to be feasible for trauma resuscitation and may improve survivorship, however, the serious complication of lower limb ischemia warrants more research on its safety.
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Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients.
TL;DR: REBOA treatment is associated with higher mortality compared with similarly ill trauma patients who did not receive a REBOA, which may signal “last ditch” efforts for severity not otherwise identified in the trauma registry.
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