Abstract
BackgroundHemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe.MethodsData concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020.ResultsA total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days.ConclusionsOur clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.
Highlights
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapidly evolving technique used to temporarily stabilize hemodynamically unstable patients by aortic occlusion
This study is a retrospective analysis of prospectively collected data from Örebro University hospital, Sweden on the specific use of the emergency room (ER)-REBOATM catheter for all causes by the EndoVascular resuscitation and Trauma Management (EVTM) group led by the vascular team
During the 59-month study period, a total of 43 cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) using various REBOA catheters were reported at Örebro University Hospital, Sweden
Summary
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapidly evolving technique used to temporarily stabilize hemodynamically unstable patients by aortic occlusion It is used in both traumatic and non-traumatic causes of truncal exsanguination [1,2,3,4]. Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA) This is a report of a single-center experience using the ER-REBOATM catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. Conclusions Our clinical data and experience show that the ER-REBOATM catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality
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