Abstract
IntroductionIntra-aortic balloon occlusion (IABO) is useful for proximal vascular control, by clamping the descending aorta, in traumatic haemorrhagic shock. However, there are limited clinical studies regarding its effectiveness. This study aimed at investigating the effectiveness of IABO for traumatic haemorrhagic shock.MethodsThis retrospective, observational study included trauma patients who underwent IABO at the Emergency and Critical Care Center of Nippon Medical School Tama-Nagayama Hospital between January 2009 and March 2013. 14 patients were included to this study who were in shock on arrival (systolic blood pressure [SBP] <90 mmHg or shock index ≥1), underwent IABO for resuscitation and temporary haemostasis, and subsequently underwent haemostatic intervention (operation or transcatheter arterial embolization). Patient characteristics, physiological status, SBP, heart rate (HR), initial fluid and blood transfusion, time course, and total occlusion time were compared before and after IABO as well as between the survived (n = 5) and non-survived (n = 9) groups.ResultsThe majority of patients experienced blunt injuries, with an average injury severity score of 29.5. The liver, pelvis, spleen, and mesenterium represented the majority of injured organs. SBP, but not HR, was significantly higher after IABO than before IABO (123.1 vs. 65.5 mmHg, P = 0.0001). The revised trauma score and probability of survival were significantly different between the survived and non-survived groups (both, P = 0.04). The survived group required significantly less blood transfusion volume than the non-survived group (20 vs. 33.7 red blood cell units, P = 0.04). In addition, the survived group required a significantly shorter total occlusion time than the non-survived group (46.2 vs. 224.1 min, P = 0.002).ConclusionsIABO was used for relatively severe trauma patients. SBP was significantly higher after IABO, but was not related to survival. However, blood transfusion volume and total occlusion time were related to survival; therefore, it is important to reduce or shorten these parameters, i.e., immediate definitive haemostasis. IABO is effective for traumatic haemorrhagic shock; however, it is also important to consider these points and potential complications.
Highlights
Intra-aortic balloon occlusion (IABO) is useful for proximal vascular control, by clamping the descending aorta, in traumatic haemorrhagic shock
It has been reported that an emergent laparotomy in injured hypotensive patients with massive hemoperitoneum frequently results in cardiac arrest as the abdominal wall tamponade is released
Systolic blood pressure and heart rate systolic blood pressure (SBP) was significantly higher after IABO than before IABO, in the entire sample (123.1 ± 10.5 vs. 65.5 ± 4.7 mmHg, probability of survival (Ps) = 0.0001) (Figure 1A)
Summary
Intra-aortic balloon occlusion (IABO) is useful for proximal vascular control, by clamping the descending aorta, in traumatic haemorrhagic shock. Occlusion of the descending aorta by intra-aortic balloon occlusion (IABO) is less invasive, and the inflation volume and duration can be controlled in response to vital signs. As a result, the latter method is increasingly being used. IABO, which was developed by Edwards et al in 1953 [3], was initially intended for surgical treatment of abdominal aortic aneurysms and was later applied to traumatic haemorrhagic shock. Stannard et al described the following IABO steps: (1) arterial access, (2) balloon selection and positioning, (3) balloon inflation, (4) balloon deflation, and (5) sheath removal [7]
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