Browse > Article
http://dx.doi.org/10.20408/jti.2020.001

Resuscitative Endovascular Balloon Occlusion of the Aorta in Impending Traumatic Arrest: Is It Effective?  

Chung, Jae Sik (Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
Kim, Oh Hyun (Department of Emergency Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
Kim, Seongyup (Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
Jang, Ji Young (Department of Surgery, National Health Insurance Service Ilsan Hospital)
An, Gyo Jin (Department of Emergency Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
Jung, Pil Young (Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
Publication Information
Journal of Trauma and Injury / v.33, no.1, 2020 , pp. 23-30 More about this Journal
Abstract
Purpose: Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations. Methods: This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups. Results: We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%. Conclusions: Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.
Keywords
Hemorrhagic shock; Endovascular procedures; Trauma;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Tien HC, Spencer F, Tremblay LN, Rizoli SB, Brenneman FD. Preventable deaths from hemorrhage at a level I Canadian trauma center. J Trauma 2007;62:142-6.   DOI
2 Sanddal TL, Esposito TJ, Whitney JR, Hartford D, Taillac PP, Mann NC, et al. Analysis of preventable trauma deaths and opportunities for trauma care improvement in utah. J Trauma 2011;70:970-7.   DOI
3 Brenner M, Inaba K, Aiolfi A, DuBose J, Fabian T, Bee T, et al. 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. J Am Coll Surg 2018;226:730-40.   DOI
4 Darrabie MD, Croft CA, Brakenridge SC, Mohr AM, Rosenthal MA, Mercier NR, et al. Resuscitative endovascular balloon occlusion of the aorta: implementation and preliminary results at an academic level I trauma center. J Am Coll Surg 2018;227:127-33.   DOI
5 Moore LJ, Brenner M, Kozar RA, Pasley J, Wade CE, Baraniuk MS, et al. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. J Trauma Acute Care Surg 2015;79:523-30; discussion 530-2.   DOI
6 Brenner ML, Moore LJ, DuBose JJ, Tyson GH, McNutt MK, Albarado RP, et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg 2013;75:506-11.   DOI
7 Martinelli T, Thony F, Declety P, Sengel C, Broux C, Tonetti J, et al. Intra-aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures. J Trauma 2010;68:942-8.
8 Morrison JJ, Galgon RE, Jansen JO, Cannon JW, Rasmussen TE, Eliason JL. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg 2016;80:324-34.   DOI
9 Tiba MH, McCracken BM, Cummings BC, Colmenero CI, Rygalski CJ, Hsu CH, et al. Use of resuscitative balloon occlusion of the aorta in a swine model of prolonged cardiac arrest. Resuscitation 2019;140:106-12.   DOI
10 Ozkurtul O, Staab H, Osterhoff G, Ondruschka B, Hoch A, Josten C, et al. Technical limitations of REBOA in a patient with exsanguinating pelvic crush trauma: a case report. Patient Saf Surg 2019;13:25.   DOI
11 Mattei TA, Teasdale GM. The story of the development and adoption of the Glasgow Coma Scale: part I, the early years. World Neurosurg 2019;134:311-22.   DOI
12 Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol 2014;13:844-54.   DOI
13 Lendrum R, Perkins Z, Chana M, Marsden M, Davenport R, Grier G, et al. Pre-hospital resuscitative endovascular balloon occlusion of the aorta (REBOA) for exsanguinating pelvic haemorrhage. Resuscitation 2019;135:6-13.   DOI
14 Abe T, Uchida M, Nagata I, Saitoh D, Tamiya N. Resuscitative endovascular balloon occlusion of the aorta versus aortic cross clamping among patients with critical trauma: a nationwide cohort study in Japan. Crit Care 2016;20:400.   DOI
15 Matsumura Y, Matsumoto J, Kondo H, Idoguchi K, Ishida T, Okada Y, et al. Early arterial access for resuscitative endovascular balloon occlusion of the aorta is related to survival outcome in trauma. J Trauma Acute Care Surg 2018;85:507-11.   DOI
16 Henry R, Matsushima K, Henry RN, Wong V, Warriner Z, Strumwasser A, et al. Who would have benefited from the prehospital use of resuscitative endovascular balloon occlusion of the aorta (REBOA)? An autopsy study. J Am Coll Surg 2019;229:383-8.e1.   DOI
17 Hughes CW. Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery 1954;36:65-8.
18 Brenner M, Teeter W, Hoehn M, Pasley J, Hu P, Yang S, et al. Use of resuscitative endovascular balloon occlusion of the aorta for proximal aortic control in patients with severe hemorrhage and arrest. JAMA Surg 2018;153:130-5.   DOI
19 Manzano-Nunez R, Naranjo MP, Foianini E, Ferrada P, Rincon E, Garcia-Perdomo HA, et al. A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients. World J Emerg Surg 2017;12:30.   DOI
20 Matsumoto S, Hayashida K, Akashi T, Jung K, Sekine K, Funabiki T, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) for severe torso trauma in Japan: a descriptive study. World J Surg 2019;43:1700-7.   DOI
21 Qasim Z, Brenner M, Menaker J, Scalea T. Resuscitative endovascular balloon occlusion of the aorta. Resuscitation 2015;96:275-9.   DOI
22 Teeter WA, Matsumoto J, Idoguchi K, Kon Y, Orita T, Funabiki T, et al. Smaller introducer sheaths for REBOA may be associated with fewer complications. J Trauma Acute Care Surg 2016;81:1039-45.   DOI
23 Matsumura Y, Matsumoto J, Kondo H, Idoguchi K, Ishida T, Kon Y, et al. Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan. Emerg Med J 2017;34:793-9.   DOI
24 Avaro JP, Mardelle V, Roch A, Gil C, de Biasi C, Oliver M, et al. Forty-minute endovascular aortic occlusion increases survival in an experimental model of uncontrolled hemorrhagic shock caused by abdominal trauma. J Trauma 2011;71:720-5; discussion 725-6.   DOI