Abstract
BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective adjunct in hemodynamic unstable patients with uncontrolled and non-compressible torso hemorrhage promoting temporary stability during injury repair. The aim of our study was to analyze real life usability of REBOA based on a case report and to review the literature with respect to its possibilities and limitations.Case presentationWe present the case of a 17-years old female patient who sustained a severe roll-over trauma and pelvic crush injury as a bicyclist by a truck. Upon arrival of the first responders, the patient was awake, alert, and following commands.Subsequent to lifting the truck, the patient became hypotensive and required cardiopulmonary resuscitation, application of a pelvic binder, and endotracheal intubation at the accident scene. She was then admitted by ambulance to our trauma center under ongoing resuscitative measures. After primary survey, it was decided to perform a REBOA with surgical approach to the left femoral artery. Initial insertion of the catheter was successful but could not be advanced beyond the inguinal region. Hence, the patient was transferred to the operating room (OR) but died despite maximum therapy. In the OR and later autopsy, we found a long-distance ruptured and dehiscent external iliac artery with massive bleeding into the pelvis in the context of a bilateral vertical shear fractured pelvic bone.ConclusionREBOA can be a useful adjunct but there is a major limitation with potential vascular injury after pelvic trauma. In these situations, cross-clamping the proximal aorta or pre-peritoneal pelvic packing as “traditional” approaches of hemorrhage control during resuscitation may be the most considerable methods for temporary stabilization in severely injured trauma patients. More clinical and cadaveric studies are needed to further understand indications and limitations of REBOA after severe pelvic trauma.
Highlights
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective adjunct in hemodynamic unstable patients with uncontrolled and non-compressible torso hemorrhage promoting temporary stability during injury repair
REBOA can be a useful adjunct but there is a major limitation with potential vascular injury after pelvic trauma
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming increasingly common in patients with severe multiple injuries [1]. It is considered an effective adjunct in hemodynamically unstable patients with uncontrolled and non-compressible torso hemorrhage promoting temporary stability during injury repair
Summary
Cross-clamping the proximal aorta or pre-peritoneal pelvic packing as “traditional” approaches for hemorrhage control during resuscitation are the most considerable methods for temporary stabilization in severely injured trauma patients and both methods are widely established during the past decades. Specific problems during balloon occlusion are accessing the wrong vascular tree, misplacement of the wire or balloon within the arterial system, the creation of dissection flaps or other arterial injury, retroperitoneal hemorrhage, the development of lactic acidosis and organ dysfunction, and the development of clots which may lead to limb ischemia [25] These complications related to vessel injuries during insertion are well described in the vascular literature [27, 28], but the majority of these studies investigates elective interventions and comparison is not adequate to high risk situations such as CPR after trauma.
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