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Hashida T, Hata N, Higashi A, Oka Y, Otani S, Watanabe E. Case Report: Lifesaving Hemostasis With Resuscitative Endovascular Balloon Occlusion of the Aorta in a Patient With Cardiac Arrest Caused by Upper Gastrointestinal Hemorrhage. Front Med (Lausanne) 2021; 8:777421. [PMID: 34796191 PMCID: PMC8592922 DOI: 10.3389/fmed.2021.777421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed to treat hemorrhagic shock, whose cause is located below the diaphragm. However, its use in patients with gastrointestinal hemorrhage is relatively rare. The 45-year-old man with a history of dilated cardiomyopathy had experienced epigastric discomfort and had an episode of presyncope. On his presentation, the patient's blood pressure was 82/64 mmHg, heart rate 140/min, and consciousness level GCS E4V5M6. Hemodynamics stabilized rapidly with a transfusion that was administered on an emergency basis, and a blood sample only showed mild anemia (Hb, 11.5 g/dL). The patient was admitted to investigating the presyncope episode, and the planned endoscopy was scheduled the following day. The patient had an episode of presyncope soon and was found in hemorrhagic shock resulting from a duodenal ulcer rapidly deteriorated to cardiac arrest. Although a spontaneous heartbeat was restored with cardiopulmonary resuscitation, the patient's hemodynamics were unstable despite the emergency blood transfusion administered by pumping. Consequently, a REBOA device was placed, resuscitation was continued, and hemostasis was achieved by vascular embolization for the gastroduodenal artery. The patient was subsequently discharged without complications. However, there is no established evidence regarding the REBOA use in upper gastrointestinal hemorrhage, and the investigations that have been reported have been limited. Further, one recent research suggests that appropriate patient selection and early use may improve survival in these life-threatening cases. As was seen in the present case, REBOA can effectively treat upper gastrointestinal hemorrhage by temporarily stabilizing hemodynamics and enabling a hemostatic procedure to be quickly performed during that time. This report also demonstrated the hemodynamics during the combination of intermittent and partial REBOA to avoid the complications of ischemic or reperfusion injury of the intestines or lower extremities.
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Affiliation(s)
- Tomoaki Hashida
- Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nanami Hata
- Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Akiko Higashi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshito Oka
- Department of Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Shunsuke Otani
- Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eizo Watanabe
- Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane, Japan.,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
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Marsh AM, Betzold R, Rueda M, Morrow M, Lottenberg L, Borrego R, Ghneim M, DuBose JJ, Morrison JJ, Azar FK. Clinical Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Management of Hemorrhage Control: Where Are We Now? CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hilbert-Carius P, McGreevy D, Abu-Zidan FM, Hörer TM. Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry. World J Emerg Surg 2020; 15:62. [PMID: 33228705 PMCID: PMC7685615 DOI: 10.1186/s13017-020-00342-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about "Who is and who should be performing it?" METHODS Data from the international ABO (aortic balloon occlusion) Trauma Registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how, and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients. RESULTS During the study period, 259 patients had been recorded in the registry, 72.5% (n = 188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5%, and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common femoral artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cutdown in 57 patients (24%), using ultrasound in 49 patients (21%), and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient's age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room, and mortality. CONCLUSION A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cutdown is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing "Who should be performing REBOA?" future research should focus on "Which patient benefits most from REBOA?"
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Affiliation(s)
- Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital Halle, Mersbuegerstraße 165, 06112, Halle (Saale), Germany.
| | - David McGreevy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates
| | - Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of General Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Giordano V, Giannoudis VP, Giannoudis PV. Current trends in resuscitation for polytrauma patients with traumatic haemorrhagic shock. Injury 2020; 51:1945-1948. [PMID: 32829760 DOI: 10.1016/j.injury.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Vincenzo Giordano
- Hospital Municipal Miguel Couto, Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro - Rio de Janeiro - RJ - Brasil
| | - Vasileios P Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.
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Stubbs MK, Wellbeloved MA, Vally JC. The management of patients with placenta percreta: A case series comparing the use of resuscitative endovascular balloon occlusion of the aorta with aortic cross clamp. Indian J Anaesth 2020; 64:520-523. [PMID: 32792719 PMCID: PMC7398021 DOI: 10.4103/ija.ija_121_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/12/2020] [Accepted: 04/22/2020] [Indexed: 12/03/2022] Open
Abstract
Due to the rising caesarean section (CS) rate, there has been an increase in placenta percreta (PP) cases. Resuscitative endovascular balloon occlusion of the aorta (REBOA) use has been successful in obstetric surgery for PP. In our institution, it has been introduced for prophylactic and therapeutic management in patients with PP. In our environment, the risks, benefits, and associated cost of REBOA use needed to be determined. In this case series, we report on five patients with PP where REBOA or aortic cross clamp were used and examine the associated outcomes.
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Affiliation(s)
- Melissa K Stubbs
- Department of Anaesthesia, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan A Wellbeloved
- Department of Anaesthesia, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janine C Vally
- Department of Anaesthesia, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Meléndez JJ, Ordóñez CA, Parra MW, Orlas CP, Manzano-Núñez R, García AF, Salazar CJ, Londoño MA, Ruíz JE, Serna JJ, Angamarca E, Salcedo A, Peña CA, Rodríguez F. Balón de reanimación endovascular de aorta para pacientes en riesgo de o en choque hemorrágico: experiencia en un centro de trauma de Latinoamérica. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Castaneda K, Puckett Y, Leal A, Ronaghan CA. Deployment of a Resuscitative Endovascular Balloon Occlusion of the Aorta Device in a Case of Gunshot Wound Injury to a Horseshoe Kidney. Cureus 2018; 10:e3399. [PMID: 30533333 PMCID: PMC6279008 DOI: 10.7759/cureus.3399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A horseshoe kidney (HSK) is a urological malformation that is typically found incidentally after a traumatic injury due to its asymptomatic nature. We present a 25-year-old male with multiorgan injuries secondary to blunt abdominal trauma caused by a gunshot wound. We report the courses of action taken that led to the identification of the HSK and other associated intra-abdominal injuries and the subsequent surgical management. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an improving minimally invasive technique that was used to control hemorrhage in the early preoperative stages and during surgical repair of the injuries. Multiorgan injuries that involve an HSK are uncommon. Our interest in the case relies on the rarity and unique aspects of the injuries and the recovery of the patient following the use of REBOA.
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Affiliation(s)
- Karen Castaneda
- Miscellaneous, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Yana Puckett
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Andres Leal
- Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
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Ribeiro Junior MAF, Feng CYD, Nguyen ATM, Rodrigues VC, Bechara GEK, de-Moura RR, Brenner M. The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). World J Emerg Surg 2018; 13:20. [PMID: 29774048 PMCID: PMC5948672 DOI: 10.1186/s13017-018-0181-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/07/2018] [Indexed: 11/21/2022] Open
Abstract
Non-compressible torso hemorrhage (NCTH) remains a significant cause of morbidity and mortality in the field of trauma and emergency medicine. In recent times, there has been a resurgence in the adoption of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for patients who present with NCTH. Like all medical procedures, there are benefits and risks associated with the REBOA technique. However, in the case of REBOA, these complications are not unanimously agreed upon with varying viewpoints and studies. This article aims to review the current knowledge surrounding the complications of the REBOA technique at each step of its application.
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Affiliation(s)
| | - Celia Y D Feng
- 2School of Medicine, University of New South Wales, Sydney, New South Wales Australia
| | - Alexander T M Nguyen
- 2School of Medicine, University of New South Wales, Sydney, New South Wales Australia
| | - Vinicius C Rodrigues
- 1Disciplina de Cirurgia Geral e Trauma, Universidade Santo Amaro, São Paulo, São Paulo Brazil
| | - Giovana E K Bechara
- 1Disciplina de Cirurgia Geral e Trauma, Universidade Santo Amaro, São Paulo, São Paulo Brazil
| | - Raíssa Reis de-Moura
- 1Disciplina de Cirurgia Geral e Trauma, Universidade Santo Amaro, São Paulo, São Paulo Brazil
| | - Megan Brenner
- 3RA Cowley Shock Trauma Center, University of Maryland, Baltimore, MD USA
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