Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrahgic shock as an adjunct to haemostatic procedures in the acute care setting.

Junya Tsurukiri,Takao Sato,Mariko Moriya,Itsurou Akamine,Shoichi Ohta,Hiroshi Yamanaka,Eitaro Okumura,Masatsugu Sakurai

doi:10.1186/s13049-016-0205-8

Abstract

BackgroundHaemorrhagic shock is a major cause of death in the acute care setting. Since 2009, our emergency department has used intra-aortic balloon occlusion (IABO) catheters for resuscitative endovascular balloon occlusion of the aorta (REBOA).MethodsREBOA procedures were performed by one or two trained acute care physicians in the emergency room (ER) and intensive care unit (ICU). IABO catheters were positioned using ultrasonography. Collected data included clinical characteristics, haemorrhagic severity, blood cultures, metabolic values, blood transfusions, REBOA-related complications and mortality.ResultsSubjects comprised 25 patients (trauma, n = 16; non-trauma, n = 9) with a median age of 69 years and a median shock index of 1.4. REBOA was achieved in 22 patients, but failed in three elderly trauma patients. Systolic blood pressure significantly increased after REBOA (107 vs. 71 mmHg, p < 0.01). Five trauma patients (20 %) died in ER, and mortality rates within 24 h and 60 days were 20 % and 12 %, respectively. No REBOA-related complications were encountered. The total occlusion time of REBOA was significantly lesser in survivors than that in non-survivors (52 vs. 97 min, p < 0.01). Significantly positive correlations were found between total occlusion time of REBOA and shock index (Spearman’s r = 0.6) and lactate concentration (Spearman’s r = 0.7) in survivors.ConclusionREBOA can be performed in ER and ICU with a high degree of technical success. Furthermore, correlations between occlusion time and initial high lactate levels and shock index may be important because prolonged occlusion is associated with a poorer outcome.

Highlights

Haemorrhagic shock is a major cause of death in the acute care setting
Trauma and upper gastrointestinal bleeding (UGIB) are the most common causes of haemodynamic instability in patients with haemorrhage admitted to the emergency department (ED) and persistent haemorrhage is a major cause of death in acute care management [1,2,3]
In the present study, we found that the total occlusion time of resuscitative endovascular balloon occlusion of the aorta (REBOA) was longer in non-survivors than that in survivors with similar results between trauma and nontrauma patients

Summary

Introduction

Haemorrhagic shock is a major cause of death in the acute care setting. Since 2009, our emergency department has used intra-aortic balloon occlusion (IABO) catheters for resuscitative endovascular balloon occlusion of the aorta (REBOA). The main aim of resuscitation is to stop the haemorrhage and restore circulating blood volume, persistent haemorrhage can be rapidly fatal In such cases, conventional options for impending haemodynamic collapse are resuscitative thoracotomy (RT) and aortic clamping immediately performed in the emergency room (ER), for uncontrolled torso haemorrhage or unstable pelvic fractures [4,5,6,7,8]. Conventional options for impending haemodynamic collapse are resuscitative thoracotomy (RT) and aortic clamping immediately performed in the emergency room (ER), for uncontrolled torso haemorrhage or unstable pelvic fractures [4,5,6,7,8] These procedures are invasive; resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used as an alternative to RT [9, 10]. We conducted a retrospective study of patients with haemorrhagic instability who underwent REBOA at a single emergency centre to determine the effect of REBOA on mortality and identify associations with vital indicators upon presentation at emergency facilities

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Conclusion