| 1. |
- Coccolini, F., et al.
(författare)
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Aortic balloon occlusion (REBOA) in pelvic ring injuries: preliminary results of the ABO Trauma Registry
- 2020
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Ingår i: Updates in Surgery. - : Springer Science and Business Media LLC. - 2038-131X .- 2038-3312. ; 2020:72, s. 527-536
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Tidskriftsartikel (refereegranskat)abstract
- EndoVascular and Hybrid Trauma Management (EVTM) has been recently introduced in the treatment of severe pelvic ring injuries. This multimodal method of hemorrhage management counts on several strategies such as the REBOA (resuscitative endovascular balloon occlusion of the aorta). Few data exist on the use of REBOA in patients with a severely injured pelvic ring. The ABO (aortic balloon occlusion) Trauma Registry is designed to capture data for all trauma patients in hemorrhagic shock where management includes REBOA placement. Among all patients included in the ABO registry, 72 patients presented with severe pelvic injuries and were the population under exam. 66.7% were male. Mean and median ISS were respectively 43 and 41 (SD ± 13). Isolated pelvic injuries were observed in 12 patients (16.7%). Blunt trauma occurred in 68 patients (94.4%), penetrating in 2 (2.8%) and combined in 2 (2.8%). Type of injury: fall from height in 15 patients (23.1%), traffic accident in 49 patients (75.4%), and unspecified impact in 1 patient (1.5%). Femoral access was gained pre-hospital in 1 patient, in emergency room in 43, in operating room in 12 and in angio-suite in 16. REBOA was positioned in zone 1 in 59 patients (81,9%), in zone 2 in 1 (1,4%) and in zone 3 in 12 (16,7%). Aortic occlusion was partial/periodical in 35 patients (48,6%) and total occlusion in 37 patients (51,4%). REBOA associated morbidity rate: 11.1%. Overall mortality rate was 54.2% and early mortality rate (≤ 24h) was 44.4%. In the univariate analysis, factors related to early mortality (≤ 24h) are lower pH values (p = 0.03), higher base deficit (p = 0.021), longer INR (p = 0.012), minor increase in systolic blood pressure after the REBOA inflation (p = 0.03) and total aortic occlusion (p = 0.008). None of these values resulted significant in the multivariate analysis. In severe hemodynamically unstable pelvic trauma management, REBOA is a viable option when utilized in experienced centers as a bridge to other treatments; its use might be, however, accompanied with severe-to-lethal complications. © 2020, Italian Society of Surgery (SIC).
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| 2. |
- Hilbert-Carius, Peter, et al.
(författare)
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Pre-hospital CPR and early REBOA in trauma patients-results from the ABOTrauma Registry
- 2020
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Ingår i: World Journal of Emergency Surgery. - : Springer Science and Business Media LLC. - 1749-7922. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 The Author(s). Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to the hospital with ongoing CPR. Nine patients (35%) died within the first 24 h, while seventeen patients (65%) survived post 24 h. The survival rate to hospital discharge was 27% (n = 7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p = 0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. The survival rate in the 16 patients responding to REBOA was 37.5% (n = 6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from the median (range) 56.5 (0-147) to 90 (0-200) mmHg. Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated.
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| 3. |
- Brill, Jason B., et al.
(författare)
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The Role of TEG and ROTEM in Damage Control Resuscitation
- 2021
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Ingår i: Shock. - : LIPPINCOTT WILLIAMS & WILKINS. - 1073-2322 .- 1540-0514. ; 56:1S, s. 52-61
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Tidskriftsartikel (refereegranskat)abstract
- Trauma-induced coagulopathy is associated with very high mortality, and hemorrhage remains the leading preventable cause of death after injury. Directed methods to combat coagulopathy and attain hemostasis are needed. The available literature regarding viscoelastic testing, including thrombelastography (TEG) and rotational thromboelastometry (ROTEM), was reviewed to provide clinically relevant guidance for emergency resuscitation. These tests predict massive transfusion and developing coagulopathy earlier than conventional coagulation testing, within 15 min using rapid testing. They can guide resuscitation after trauma, as well. TEG and ROTEM direct early transfusion of fresh frozen plasma when clinical gestalt has not activated a massive transfusion protocol. Reaction time and clotting time via these tests can also detect clinically significant levels of direct oral anticoagulants. Slowed clot kinetics suggest the need for transfusion of fibrinogen via concentrates or cryoprecipitate. Lowered clot strength can be corrected with platelets and fibrinogen. Finally, viscoelastic tests identify fibrinolysis, a finding associated with significantly increased mortality yet one that no conventional coagulation test can reliably detect. Using these parameters, guided resuscitation begins within minutes of a patients arrival. A growing body of evidence suggests this approach may improve survival while reducing volumes of blood products transfused.
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| 4. |
- Buitendag, Johan, et al.
(författare)
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Comparison of Outcomes Relating to REBOA Inflation Zones : Report from the ABO Trauma Registry
- 2023
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Ingår i: Journal of Endovascular Resuscitation and Trauma Management (JEVTM). - : Örebro University Hospital and University i samarbeid med 'Society of Endovascular Resuscitation and Trauma Management'. - 2002-7567 .- 2003-539X. ; 7:1, s. 15-21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporary management modality for non-compressible torso haemorrhage that can be deployed in the pre- and intrahospital setting. This study aimed to compare outcomes following balloon placement in the three aortic zones.Methods: This is a retrospective study using data from the ABO Trauma Registry. Relevant entries from January 2014 to December 2019 were used and stratified into three groups: those who received Zone 1, 2, or 3 balloon placements.Results: The study sample consisted of 237 patients: 63 (27%) women and 174 (73%) men, median age 35 years. The primary location of the REBOA balloon was in Zone 1 for 180 patients, while it was nine in Zone 2 and 48 in Zone 3. Complication rates and total durations did not differ significantly between inflation zones. Emergency department mortality rates for Zones 1 and 2 patients were significantly higher than for Zone 3 (P = 0.04), but there was no difference between groups in 24-hour and 30-day mortality rates.Conclusions: REBOA is currently used in the emergency setting for temporary stabilisation of the bleeding patient. In this cohort, balloon placement occurred in all zones of the aorta for similar durations, with no difference in complication rates between zones. Inadvertent Zone 2 placement was not found to be associated with increased complication rates.
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| 5. |
- Buitendag, Johan, et al.
(författare)
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Use of Intermittent Aortic Balloon Occlusion : Report from the ABO Trauma Registry
- 2023
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Ingår i: Journal of Endovascular Resuscitation and Trauma Management. - : Örebro University Hospital and University i samarbeid med 'Society of Endovascular Resuscitation and Trauma Management'. - 2002-7567 .- 2003-539X. ; 7:1, s. 8-14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a helpful adjunct in the management of hemorrhagic shock due to bleeding in the abdomen or pelvis. Ischemia distal to the occlusion is a concern; intermittent aortic balloon inflation (i-REBOA) is a novel way to achieve decreased ischemia time.Methods: This study was conducted using data from the multinational ABO Trauma Registry. All patients entered between January 2016 and December 2019 were included.Results: The sample consisted of 157 patients. There were 57 patients in the i-REBOA group (36%) and 100 in the REBOA group (64%). The groups were similar in gender (P = 0.50), age (P = 0.17), mechanism of injury (P = 0.42), and injury severity score (P = 0.13). The levels of international normalized ratio (INR) (P < 0.01), activated partial thromboplastin time (aPTT) (P < 0.01) and lactate (P = 0.02) were higher in the i-REBOA group. Total balloon inflation times were longer in the i-REBOA group (P < 0.01). Major complication rates did not differ between groups. Mortality rates between groups were similar in the Emergency Department (ED) (3.8% for i-REBOA vs 10.1%; P = 0.17), within 24 hours (43.4% for i-REBOA vs 38.2%; P = 0.54), and at 30 days (63.6% for i-REBOA vs 48.4%; P = 0.07).Conclusions: The data from this registry show that i-REBOA is currently being used and may allow for longer total balloon inflation times without higher morbidity or mortality rates.
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| 6. |
- Coccolini, Federico, et al.
(författare)
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Liver trauma : WSES 2020 guidelines
- 2020
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Ingår i: World Journal of Emergency Surgery. - : BioMed Central (BMC). - 1749-7922. ; 15:1
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Forskningsöversikt (refereegranskat)abstract
- Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.
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| 7. |
- Dogan, Emanuel M., 1984-
(författare)
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Endovascular occlusion methods in non-traumatic cardiac arrest
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Approximately 10% of out-of-hospital cardiac arrest patients survive to hospital discharge. An important factor for survival is perfusion to the coronary and cerebral circulations during cardiopulmonary resuscitation (CPR). Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular method used to centralize the circulation and augment blood flow to the heart and brain. REBOA is mostly used in trauma patients but its use in non-traumatic cardiac arrest (NTCA) is evolving. The effects and optimal location of REBOA during CPR are, however, not well-known. Intra-aortic balloon pump (IABP) is another endovascular method which, unlike REBOA, inflates and deflates in correlation with the heart’s contraction and relaxation cycles. IABP is mostly used in patients with cardiogenic shock and its usage has been sparsely studied in NTCA. In addition, there are no studies evaluating if an intra-caval balloon pump (ICBP) could increase venous return during CPR. The aim of this thesis was to investigate endovascular occlusion methods in NTCA and how they influence the hemodynamic parameters during CPR. All studies were experimental where a total of 133 pigs were included.In Study I, REBOA increased systemic blood pressures while causing an ischemic insult to organs distal to the occlusion, already at 30 min of occlusion.Study II showed that a REBOA placed below the heart and outside of the compression field increased arterial blood pressures more than if the REBOA was placed behind the heart during NTCA and CPR.Study III compared REBOA in zone I (thoracic) with REBOA in zone III (infrarenal) during experimental CPR. Zone III REBOA did not yield the same favorable circulatory response as zone I REBOA.Study IV showed that IABP increased hemodynamic values if it was inflated before the chest compression. An ICBP did not improve hemodynamic values.Conclusion: REBOA caused a time-dependent ischemic insult, a maximum total occlusion time of 15-30 min is suggested. When an optimally placed REBOA and an optimally synchronized IABP are used in NTCA and CPR, they improve hemodynamic variables.
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| 8. |
- Dogan, Emanuel M., 1984-, et al.
(författare)
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Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation
- 2023
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Ingår i: Journal of Cardiovascular Translational Research. - : Springer-Verlag New York. - 1937-5387 .- 1937-5395. ; 16:4, s. 948-955
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Tidskriftsartikel (refereegranskat)abstract
- Intra-aortic balloon pump (IABP) use during CPR has been scarcely studied. Intra-caval balloon pump (ICBP) may decrease backward venous flow during CPR. Mechanical chest compressions (MCC) were initiated after 10 min of cardiac arrest in anesthetized pigs. After 5 min of MCC, IABP (n = 6) or ICBP (n = 6) was initiated. The MCC device and the IABP/ICBP had slightly different frequencies, inducing a progressive peak pressure phase shift. IABP inflation 0.15 s before MCC significantly increased mean arterial pressure (MAP) and carotid blood flow (CBF) compared to inflation 0.10 s after MCC and to MCC only. Coronary perfusion pressure significantly increased with IABP inflation 0.25 s before MCC compared to inflation at MCC. ICBP inflation before MCC significantly increased MAP and CBF compared to inflation after MCC but not compared to MCC only. This shows the potential of IABP in CPR when optimally synchronized with MCC. The effect of timing of intra-aortic balloon pump (IABP) inflation during mechanical chest compressions (MCC) on hemodynamics. Data from12 anesthetized pigs.
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| 9. |
- Dogan, Emanuel M., 1984-, et al.
(författare)
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Resuscitative endovascular balloon occlusion of the aorta in zone I versus zone III in a porcine model of non-traumatic cardiac arrest and cardiopulmonary resuscitation : A randomized study
- 2020
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Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 151, s. 150-156
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) in zone I increases systemic blood pressure during cardiopulmonary resuscitation (CPR), while also obstructing the blood flow to distal organs. The aim of the study was to compare the effects on systemic blood pressure and visceral blood flow of REBOA-III (zone III, infrarenal) and REBOA-I (zone I, supraceliac) during non-traumatic cardiac arrest and CPR.METHODS: Cardiac arrest was induced in 61 anesthetized pigs. Thirty-two pigs were allocated to a hemodynamic study group where the primary outcomes were systemic arterial pressures and 29 pigs were allocated to a blood flow study group where the primary outcomes were superior mesenteric arterial (SMA) and internal carotid arterial (ICA) blood flow. After 7-8minutes of CPR with a mechanical compression device, REBOA-I, REBOA-III or no aortic occlusion (control group) were initiated after randomization.RESULTS: Systemic mean and diastolic arterial pressures were statistically higher during CPR with REBOA-I compared to REBOA-III (50mmHg and 16mmHg in REBOA-I vs 38mmHg and 1mmHg in REBOA-III). Systemic systolic, mean and diastolic arterial pressures were statistically elevated during CPR in the REBOA-I group compared to the controls. The SMA blood flow increased by 49% in REBOA-III but dropped to the levels of the controls within minutes. The ICA blood flow increased the most in REBOA-I compared to REBOA-III and the control group (54%, 19% and 0%, respectively).CONCLUSION: In experimental non-traumatic cardiac arrest and CPR, REBOA-I increased systemic blood pressures more than REBOA-III, and the potential enhancement of visceral organ blood flow by REBOA-III was short-lived.
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| 10. |
- D'Oria, Mario, et al.
(författare)
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An International Expert-Based CONsensus on Indications and Techniques for aoRtic balloOn occLusion in the Management of Ruptured Abdominal Aortic Aneurysms (CONTROL-RAAA)
- 2023
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Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To report on the recommendations of an expert-based consensus on the indications, timing, and techniques of aortic balloon occlusion (ABO) in the management of ruptured abdominal aortic aneurysms (rAAA).METHODS: Eleven facilitators created appropriate statements regarding the study issues that were voted on using a 4-point Likert scale with open-comment fields, by a selected panel of international experts (vascular surgeons and interventional radiologists) using a 3-round modified Delphi consensus procedure (study period: January-April 2023). Based on the experts' responses, only the statements reaching grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final study report. The consistency of each round's answers was also graded using Cohen's kappa, the intraclass correlation coefficient, and, in case of double resubmission, Fleiss kappa.RESULTS: Sixty-three experts were included in the final analysis and voted on 25 statements related to indication and timing (n=6), and techniques (n=19) of ABO in the setting of rAAA. Femoral sheath or ABO should be preferably placed in the operating room, via a percutaneous transfemoral access, on a stiff wire (grade B, consistency I), ABO placement should be suprarenal and last less than 30 minutes (grade B, consistency II), postoperative peripheral vascular status (grade A, consistency II) and laboratory testing every 6 to 12 hours (grade B, consistency) should be assessed to detect complications. Formal training for ABO should be implemented (grade B, consistency I). Most of the statements in this international expert-based Delphi consensus study might guide current choices for indications, timing, and techniques of ABO in the management of rAAA. Clinical practice guidelines should incorporate dedicated statements that can guide clinicians in decision-making.CONCLUSIONS: At arrival and during both open or endovascular procedures for rAAA, selective use of intra-aortic balloon occlusion is recommended, and it should be performed preferably by the treating physician in aortic pathology.CLINICAL IMPACT: This is the first consensus study of international vascular experts aimed at defining the indications, timing, and techniques of optimal use of ABO in the clinical setting of rAAA. Aortic occlusion by endovascular means (or ABO) is a quick procedure in properly trained hands that may play an important role as a temporizing measure until the definitive aortic repair is achieved, whether by endovascular or open means. Since data on its use in hemodynamically unstable patients are limited in the literature, owing to practical challenges in the performance of well-conducted prospective studies, understanding real-world use by experts is of importance in addressing critical issues and identifying main gaps in knowledge.
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