Breaking Down Silos: The Joint Statement About the Clinical Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Warrants Revision

Endovascular Resuscitation and Trauma Management (EVTM)-Practical Aspects and Implementation

ABSTRACT

In recent years there has been a tremendous increase in hemorrhage control by endovascular methods. Traumatic and non-traumatic hemorrhage is being more frequently managed with endografts, embolization agents, and minimal invasive methods. These methods initially were used in hemodynamically stable patients only, whereas now these are being implemented in acute settings and hemodynamically unstable patients. The strategy of using endovascular and combined open-endo methods approach for hemodynamic instability in trauma and non-trauma patients has been named EVTM- EndoVascular resuscitation and Trauma Management. The EVTM concept will be presented in this article, describing how it is developed and used, as well as its limitations and future aspects.

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta via the Tri-Lobe Balloon Catheter

BACKGROUND

Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides a minimally invasive alternative to resuscitative thoracotomy. The high morbidity associated with prolonged aortic occlusion has given rise to the concept of partial REBOA (pREBOA). We evaluated the novel use of the GORE Tri-Lobe Balloon Catheter (GORE) as a functional pREBOA catheter and compared it with existing REBOA and pREBOA techniques in a porcine hemorrhagic shock model.

MATERIALS AND METHODS

Fifteen male Yorkshire swine were subjected to hemorrhagic shock with zone 1 aortic occlusion via standard REBOA techniques or a partial occlusion approach using a prototype pREBOA or GORE catheter. Continuous invasive monitoring was performed and laboratory values were analyzed every 30 min.

RESULTS

One animal from the GORE cohort was excluded because of early demise from nonstudy factors. Survival to 120 mins was comparable between all study groups: REBOA resulting in 40% survival, pREBOA 60%, and Gore 50% (P = 0.685). No differences in lactate, base deficit, and pH between the cohorts were demonstrated at all measured time points; however, trends toward more physiologic values were appreciated in the GORE and pREBOA cohorts. Urine output was significantly improved during the course of the study in the GORE cohort (8.77 mL/kg) versus REBOA (5.46 mL/kg) and pREBOA (4.48 mL/kg) (P = 0.001).

CONCLUSIONS

The GORE Tri-Lobe Balloon Catheter represents a potentially viable and commercially available alternative device for pREBOA that may achieve survivable hemorrhage control while preventing lethal reperfusion injury. Further studies should be performed after instrument refinement with larger study populations to confirm this potential.