Resuscitative endovascular balloon occlusion of the aorta for non-traumatic intra-abdominal hemorrhage.
Hemorrhagic shock
Non-compressible abdominal hemorrhage
REBOA
Shock
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
01
03
2018
accepted:
12
06
2018
pubmed:
21
6
2018
medline:
6
2
2020
entrez:
21
6
2018
Statut:
ppublish
Résumé
Hemorrhagic shock is the second leading cause of death in blunt trauma and a significant cause of mortality in non-trauma patients. The increased use of resuscitative endovascular balloon occlusion of the aorta (REBOA) as a bridge to definitive control for massive hemorrhage has provided promising results in the trauma population. We describe an extension of this procedure to our hemodynamically unstable non-trauma patients. This is a retrospective review of patients requiring REBOA for end stage non-traumatic abdominal hemorrhage from our tertiary care facility. After excluding patients with trauma, supradiaphragmatic bleed and thoracic/abdominal aortic aneurysms, demographics, etiology of bleed, REBOA placement specifics, complications and outcomes were reviewed. From August 2013 to August 2016, 11 patients were identified requiring REBOA placement for hemodynamic instability from non-traumatic abdominal hemorrhage. Average patient age was 54.9 (SD 15.2). Sixty-four percent suffered cardiac arrest prior to REBOA, with mean shock index of 1.29. Average time from diagnosis of shock (MAP ≤ 65) or signs of bleeding to placement of REBOA was 177 min. The leading etiologies of hemorrhage were ruptured visceral aneurysm and massive upper gastrointestinal bleed. REBOA was placed by both acute care and vascular surgeons. The procedure was mainly completed in the operating room in 82% of the patients and at the bedside in 18%. One patient expired before operative repair. Definitive surgical control of the source of bleeding was obtained by open surgical approach (n = 6) and combined surgical and endovascular approach (n = 4). In-hospital survival was 64%. There were no local complications related to REBOA placement. Similar to the trauma population, REBOA is an adjunctive technique for proximal control of bleeding as well as resuscitation in end stage non-traumatic intra-abdominal hemorrhage. We propose an algorithmic approach to REBOA use in this population and a larger prospective review is necessary to determine both the timing of REBOA placement and which non-traumatic patients may benefit from this technique. V. Brief report.
Sections du résumé
BACKGROUND
BACKGROUND
Hemorrhagic shock is the second leading cause of death in blunt trauma and a significant cause of mortality in non-trauma patients. The increased use of resuscitative endovascular balloon occlusion of the aorta (REBOA) as a bridge to definitive control for massive hemorrhage has provided promising results in the trauma population. We describe an extension of this procedure to our hemodynamically unstable non-trauma patients.
METHODS
METHODS
This is a retrospective review of patients requiring REBOA for end stage non-traumatic abdominal hemorrhage from our tertiary care facility. After excluding patients with trauma, supradiaphragmatic bleed and thoracic/abdominal aortic aneurysms, demographics, etiology of bleed, REBOA placement specifics, complications and outcomes were reviewed.
RESULTS
RESULTS
From August 2013 to August 2016, 11 patients were identified requiring REBOA placement for hemodynamic instability from non-traumatic abdominal hemorrhage. Average patient age was 54.9 (SD 15.2). Sixty-four percent suffered cardiac arrest prior to REBOA, with mean shock index of 1.29. Average time from diagnosis of shock (MAP ≤ 65) or signs of bleeding to placement of REBOA was 177 min. The leading etiologies of hemorrhage were ruptured visceral aneurysm and massive upper gastrointestinal bleed. REBOA was placed by both acute care and vascular surgeons. The procedure was mainly completed in the operating room in 82% of the patients and at the bedside in 18%. One patient expired before operative repair. Definitive surgical control of the source of bleeding was obtained by open surgical approach (n = 6) and combined surgical and endovascular approach (n = 4). In-hospital survival was 64%. There were no local complications related to REBOA placement.
CONCLUSION
CONCLUSIONS
Similar to the trauma population, REBOA is an adjunctive technique for proximal control of bleeding as well as resuscitation in end stage non-traumatic intra-abdominal hemorrhage. We propose an algorithmic approach to REBOA use in this population and a larger prospective review is necessary to determine both the timing of REBOA placement and which non-traumatic patients may benefit from this technique.
LEVEL OF EVIDENCE
METHODS
V.
STUDY TYPE
METHODS
Brief report.
Identifiants
pubmed: 29922894
doi: 10.1007/s00068-018-0973-0
pii: 10.1007/s00068-018-0973-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
713-718Références
J Endovasc Ther. 2000 Feb;7(1):1-7
pubmed: 10772742
Am J Emerg Med. 2002 Sep;20(5):453-62
pubmed: 12216044
Surgery. 1954 Jul;36(1):65-8
pubmed: 13178946
J Endovasc Ther. 2005 Oct;12(5):556-9
pubmed: 16212455
J Surg Res. 1990 Sep;49(3):217-21
pubmed: 2395367
Resuscitation. 2015 Nov;96:275-9
pubmed: 26386370
J Trauma Acute Care Surg. 2016 Feb;80(2):324-34
pubmed: 26816219
Scand J Trauma Resusc Emerg Med. 2016 Feb 09;24:13
pubmed: 26861070
J Trauma Acute Care Surg. 2016 Sep;81(3):409-19
pubmed: 27050883
World J Emerg Surg. 2016 May 20;11:20
pubmed: 27213011