Management of Intra-Abdominal Hemorrhagic Shock Using REBOA

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Hemorrhage is the leading cause of potentially preventable death after a traumatic injury. 1 Scott DJ Eliason JL Villamaria C et al. A novel fluoroscopy-free, resuscitative endovascular aortic balloon occlusion system in a model of hemorrhagic shock. J Trauma Acute Care Surg. 2013; 75: 122-128 Crossref PubMed Scopus (104) Google Scholar , 2 Brenner ML Moore LJ DuBose JJ et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg. 2013; 75: 506-511 Crossref PubMed Google Scholar , 3 Norii T Crandall C Terasaka Y Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients. J Trauma Acute Care Surg. 2015; 78: 721-728 Crossref PubMed Scopus (141) Google Scholar Noncompressible torso hemorrhage (NCTH), which is a disruption of the vascular activity of the axial torso vessels, pulmonary parenchyma, solid organs, or the bony pelvis, accompanied by shock, 4 Morrison JJ Stannard A Rasmussen TE et al. Injury pattern and mortality of noncompressible torso hemorrhage in UK combat casualties. J Trauma Acute Care Surg. 2013; 75: S263-S268 Crossref PubMed Scopus (79) Google Scholar has an associated mortality of approximately 45%. 5 Kisat M Morrison JJ Hashmi ZG et al. Epidemiology and outcomes of non-compressible torso hemorrhage. J Surg Res. 2013; 184: 414-421 Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar A significant number of these deaths often occur because of the delay in definitive hemorrhage control in an operative theater or interventional radiology suite. Therefore, a need for adjunct hemorrhage control is paramount to attaining temporary control of bleeding until definitive hemostasis can be achieved. 3 Norii T Crandall C Terasaka Y Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients. J Trauma Acute Care Surg. 2015; 78: 721-728 Crossref PubMed Scopus (141) Google Scholar , 4 Morrison JJ Stannard A Rasmussen TE et al. Injury pattern and mortality of noncompressible torso hemorrhage in UK combat casualties. J Trauma Acute Care Surg. 2013; 75: S263-S268 Crossref PubMed Scopus (79) Google Scholar , 5 Kisat M Morrison JJ Hashmi ZG et al. Epidemiology and outcomes of non-compressible torso hemorrhage. J Surg Res. 2013; 184: 414-421 Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar A key to improving outcomes in patients with NCTH is a “bundle” of measures that can facilitate early diagnosis, rapid control of hemorrhage, systemic and topical hemostatic support, and a short time at the scene. In the past decade a paradigm shift has occurred in treatment strategies and transfusion algorithms, with emphasis on hemostatic or damage control resuscitation. 2 Brenner ML Moore LJ DuBose JJ et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg. 2013; 75: 506-511 Crossref PubMed Google Scholar , 6 Stannard A Eliason JL Rasmussen TE Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma. 2011; 71: 1869-1872 Crossref PubMed Scopus (355) Google Scholar Jennifer Adamski is Assistant Professor, Clinical Track, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.