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- Manzano-Nunez, Ramiro, et al.
(författare)
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Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries
- 2020
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Ingår i: World Journal of Emergency Surgery. - : Springer Science and Business Media LLC. - 1749-7922. ; 15:57
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 The Author(s). Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries' income based on the World Bank Country and Lending Groups. Methods: We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results: A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36-1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63-3,33; p = 0.3). Conclusion: There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.
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| 2. |
- McGreevy, David, 1988-, et al.
(författare)
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Feasibility and Clinical Outcome of Reboa in Patients with Impending Traumatic Cardiac Arrest
- 2020
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Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 54:2, s. 218-223
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 4. |
- Reva, Viktor A., et al.
(författare)
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Extracorporeal Cardio-Pulmonary Resuscitation (E-CPR) in Traumatic Cardiac Arrests Caused by Penetrating Thoracic Injuries : A Series of Two Cases
- 2020
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Ingår i: Journal of endovascular resuscitation and trauma management. - Örebro : Örebro University Hospital. - 2002-7567. ; 4:1, s. 63-68
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Tidskriftsartikel (refereegranskat)abstract
- Background: We present two cases of thoracic penetrating injuries that necessitated extracorporeal cardiopulmonary resuscitation (E-CPR).Methods: Two male patients were admitted to hospital within 20-25 min: one with a chest stab wound and the other with a gunshot injury. Upon ongoing CPR, patient #1 underwent resuscitative sternotomy. Bleeding from a right ventricle injury was controlled, but cardiac arrest (CA) re-occurred. Patient #2 underwent immediate surgery due to multiple rib fractures and massive hemopneumothorax, and experienced multiple CAs. Due to refractory asystole with ongoing CPR, extracorporeal membrane oxygenation (ECMO) was initiated after 100 and 135 min, respectively. Primary lactate levels in cases #1 and #2 were 8 and 20 mmol/L, respectively.Results: In both cases, the femoral artery (17-19 Fr) and vein (25-27 Fr) were cannulated and connected to the Maquet ECMO circuit with a flow rate of 4-5 L/min. Return of spontaneous circulation was achieved within 20 min after ECMO initiation with relative stabilization. In patient #1, postoperative bleeding necessitated re-thoracotomy and hemorrhage control. In patient #2, left pulmonectomy and ligation of intercostal arteries was performed. 12/30 units of red blood cells, 16/45 units of fresh frozen plasma, and 2/8 units of platelets were given in cases #1/2, respectively. Lactate level increased to 25 mmol/L and decreased to 8 mmol/L in 5 hours, respectively. Both patients died in the ICU within 9 and 13 hours after admission due to bleeding.Conclusions: E-CPR allows vital function protection even in traumatic CA but necessitates appropriate resuscitation. If no bleeding control is achieved, then E-CPR is futile.
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| 5. |
- Reva, Viktor A., et al.
(författare)
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Field and en route resuscitative endovascular occlusion of the aorta : A feasible military reality?
- 2017
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Ingår i: Journal of Trauma and Acute Care Surgery. - Philadelphia, PA, United States : Lippincott Williams & Wilkins. - 2163-0755 .- 2163-0763. ; 83:1, s. S170-S176
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Severe non-compressible torso hemorrhage (NCTH) remains a leading cause of potentially preventable death in modern military conflicts. Resuscitative endovascular occlusion of the aorta (REBOA) has demonstrated potential as an effective adjunct to the treatment of NCTH in the civilian early hospital and even pre-hospital settings - but the application of this technology for military pre-hospital use has not been well described. We aimed to assess the feasibility of both field and en route pre-hospital REBOA in the military exercise setting simulating a modern armed conflict.METHODS: Two adult male Sus Scrofa underwent simulated junctional combat injury in the context of a planned military training exercise. Both underwent zone I REBOA in conjunction with standard tactical combat casualty care (TCCC) interventions - one during point of injury care and the other during en route flight care. Animals were sequentially evacuated to two separate Forward Surgical Teams (FSTs) by rotary wing platform where the balloon position was confirmed by chest X-Ray. Animals then underwent different damage control thoracic and abdominal procedures before euthanasia.RESULTS: The first swine underwent immediate successful REBOA at the point of injury 7:30 minutes after the injury. It required 6 minutes total from initiation of procedure to effective aortic occlusion. Total occlusion time was 60 minutes. In the second animal, the REBOA placement procedure was initiated immediately after take-off (17:40 minutes after the injury). Although the movements and vibration of flight were not significant impediments, we only succeeded to put a 6-Fr sheath into a femoral artery during the 14 minutes flight due to lighting and visualization challenges. After the sheath had been upsized in the FST, the REBOA catheter was primarily placed in zone I followed by its replacement to zone III. Both animals survived to study completion and the termination of training. No complications were observed in either animal.CONCLUSION: Our study demonstrates the potential feasibility of REBOA for use during tactical field and en route (flight) care of combat casualties. Further study is needed to determine the optimal training and utilization protocols required to facilitate the effective incorporation of REBOA into military pre-hospital care capabilities.
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| 6. |
- Sadeghi, Mitra, 1982-, et al.
(författare)
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The use of aortic balloon occlusion in traumatic shock : first report from the ABO trauma registry
- 2018
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Berlin/Heidelberg. - 1863-9933 .- 1863-9941 .- 1615-3146. ; 44:4, s. 491-501
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary stabilization of patients with non-compressible torso hemorrhage. This technique has been increasingly used worldwide during the past decade. Despite the good outcomes of translational studies, clinical studies are divided. The aim of this multicenter-international study was to capture REBOA-specific data and outcomes.METHODS: REBOA practicing centers were invited to join this online register, which was established in September 2014. REBOA cases were reported, both retrospective and prospective. Demographics, injury patterns, hemodynamic variables, REBOA-specific data, complications and 30-days mortality were reported.RESULTS: Ninety-six cases from 6 different countries were reported between 2011 and 2016. Mean age was 52 ± 22 years and 88% of the cases were blunt trauma with a median injury severity score (ISS) of 41 (IQR 29-50). In the majority of the cases, Zone I REBOA was used. Median systolic blood pressure before balloon inflation was 60 mmHg (IQR 40-80), which increased to 100 mmHg (IQR 80-128) after inflation. Continuous occlusion was applied in 52% of the patients, and 48% received non-continuous occlusion. Occlusion time longer than 60 min was reported as 38 and 14% in the non-continuous and continuous groups, respectively. Complications, such as extremity compartment syndrome (n = 3), were only noted in the continuous occlusion group. The 30-day mortality for non-continuous REBOA was 48%, and 64% for continuous occlusion.CONCLUSIONS: This observational multicenter study presents results regarding continuous and non-continuous REBOA with favorable outcomes. However, further prospective studies are needed to be able to draw conclusions on morbidity and mortality.
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