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- 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. |
- 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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| 3. |
- Pirouzram, Artai, 1970-
(författare)
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Experimental and Clinical Studies in Ruptured Abdominal Aortic Aneurysm : Aspects of Hypothermia and Endovascular Treatment
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ruptured Abdominal Aortic Aneurysm (rAAA) is a life-threatening medical condition with historically reported mortality rates of 80%. Open aortic surgery was for the first time performed in 1950s. EndoVscular Aortic Repair (EVAR) was introduced in the 1990s as a minimally invasive treatment alternative because complications after open surgery of rAAA were relatively common. EVAR resulted in substantially lower short-term mortality, but still the life of one in four patients cannot be saved.The overarching aim of this research project was to study effects of induced hypothermia on survival in hemorrhagic shock caused by bleeding into the retroperitoneal room because of aortic rupture, and the effects of accidental hypothermia and the long-term outcomes of EVAR in treatment of rAAA.Experimental studies (1 & 2): In absence of a validated model, we created an experimental model, in anesthetized pigs (19 animals), to study size-controlled rupture in the posterolateral aortic wall with retroperitoneal bleeding. This model proved to be accurate and reproducible.Using this novel model, we studied the effects of moderate induced hypothermia on survival. In a randomized comparison (10 animals in each arm), we found that survival of the experimental animals was not impaired by induced hypothermia.Clinical studies (3 & 4): Patients treated with an EVAR-only treatment strategy in rAAA, in a single center, between October 2009-, until September 2021 (study 3) and September 2023 (study 4) were included. The retrospective study of outcomes of EVAR, in 100 patients (75 men) with rAAA found an EVAR treatment strategy feasible. Turndown rate was only 3,5%, with patients not suitable for open surgery either. We found a 30-day mortality of 27% and one-year mortality of 37%. After three years, 40% of the patients in the cohort were still alive. Low systemic blood pressure and need for use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) were independently associated with increased 30-day mortality.In a further retrospective study (EVAR in 86 patients with rAAA), pre-, peri-, and postoperative data with focus on body temperature, blood gas analyses, transfusion needs and presence of multiorgan failure as well as 30-day, 90-day mortality, were studied in three subgroups of body temperature. Accidental hypothermia was found to be associated with deteriorated hemodynamics, with increased need for REBOA and for transfusions. The hypothermic patients suffered multiorgan failure more often. There was a higher mortality, although not statistically significant, in hypothermic patients.In conclusion, EVAR in rAAA was found to have survival outcomes that are superior to the historically published data.The favorable outcomes for hypothermia in the experimental study versus worse outcomes in the clinical study suggest that accidental hypothermia and induced hypothermia are two different entities which may set path for future studies in this field.
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