Feasibility and Clinical Outcome of Reboa in Patients with Impending Traumatic Cardiac Arrest.

BACKGROUND Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may improve Systolic Blood Pressure (SBP) in hypovolemic shock. It has, however, not been studied in patients with impending traumatic cardiac arrest (ITCA). We aimed to study the feasibility and clinical outcome of REBOA in patients with ITCA using data from the ABOTrauma Registry. METHODS Retrospective and prospective data on the use of REBOA from 16 centers globally were collected. SBP was measured both at pre- and post-REBOA inflation. Data collected included patients' demography, vascular access technique, number of attempts, catheter size, operator, zone and duration of occlusion, and clinical outcome. RESULTS There were 74 patients in this high-risk patient group. REBOA was performed on all patients. A 7-10Fr catheter was used in 66.7%, 58.5% were placed on the first attempt, 52.1% through blind insertion and 93.2% inflated in Zone I, 64.8% for a period of 30 to 60 minutes, 82.1% by ER doctors, trauma surgeons or vascular surgeons. SBP significantly improved to 90 mmHg following the inflation of REBOA. 36.6% of the patients survived. CONCLUSIONS Our study has shown that REBOA may be performed in patients with ITCA, SBP can be elevated and 36.6% of the patients survived if REBOA placement is successful.

[1]  P. Rhee,et al.  Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. , 2019, JAMA surgery.

[2]  R. Lendrum,et al.  Pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for exsanguinating pelvic haemorrhage. , 2019, Resuscitation.

[3]  Jeremy W. Cannon,et al.  AORTA Registry 7F vs 11-12 F access , 2019, Journal of Endovascular Resuscitation and Trauma Management.

[4]  T. Hörer.  Resuscitative endovascular balloon occlusion of the aorta (REBOA) and endovascular resuscitation and trauma management (EVTM): a paradigm shift regarding hemodynamic instability , 2018, European journal of trauma and emergency surgery : official publication of the European Trauma Society.

[5]  H. Kondo,et al.  Early arterial access for REBOA is related to survival outcome in trauma. , 2018, The journal of trauma and acute care surgery.

[6]  W. Teeter,et al.  Time to aortic occlusion: It’s all about access , 2017, The journal of trauma and acute care surgery.

[7]  L. Handolin,et al.  The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry , 2017, European Journal of Trauma and Emergency Surgery.

[8]  T. Hörer,et al.  Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in a Multidisciplinary Approach , 2017, Innovations.

[9]  Jeremy W. Cannon,et al.  The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA) , 2016, The journal of trauma and acute care surgery.

[10]  Jason B. Smith,et al.  The changing face of major trauma in the UK , 2015, Emergency Medicine Journal.

[11]  T. Scalea,et al.  Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage , 2015, The journal of trauma and acute care surgery.

[12]  H. Yokota,et al.  Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta , 2015, The journal of trauma and acute care surgery.

[13]  Takayuki Ogura,et al.  Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta , 2015, The journal of trauma and acute care surgery.

[14]  V. Strambu,et al.  Traumatic cardiac arrest in the emergency department– Overview upon primary causes , 2014, Journal of medicine and life.

[15]  M. Midwinter,et al.  Resuscitative Endovascular Balloon Occlusion of the Aorta: A Gap Analysis of Severely Injured UK Combat Casualties , 2014, Shock.

[16]  R. McIntyre,et al.  Western Trauma Association Critical Decisions in Trauma: Resuscitative thoracotomy , 2012, The journal of trauma and acute care surgery.

[17]  Todd E Rasmussen,et al.  Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. , 2011, The Journal of trauma.

[18]  Jeremy W. Cannon,et al.  Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. , 2011, Surgery.

[19]  Alan C Elliott,et al.  Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample. , 2006, American journal of surgery.

[20]  M. Frenneaux,et al.  Haemodynamics of cardiac arrest and resuscitation , 2006, Current opinion in critical care.

[21]  James W. Davis,et al.  Are automated blood pressure measurements accurate in trauma patients? , 2003, The Journal of trauma.

[22]  C. Deakin,et al.  Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study , 2000, BMJ : British Medical Journal.

[23]  H. Kondo,et al.  Early arterial access for REBOA is related to survival outcome in trauma. , 2018, The journal of trauma and acute care surgery.

[24]  M. Sambor.  Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhage Control in Trauma Patients: An Evidence-Based Review , 2018, Journal of trauma nursing : the official journal of the Society of Trauma Nurses.