Foley Catheter Balloon Tamponade Research Articles

Use of a Rapid Rhino in haemorrhage control for penetrating neck injury presenting in traumatic cardiac arrest

Background Penetrating neck injuries present as serious, life-threatening events which require advanced expeditious management if the patient is to survive without significant morbidity and mortality. In-hospital paradigms for high-volume centres include the use of Foley catheter balloon tamponade to temporarily or definitively control haemorrhage from carotid sheath structures, although these techniques are less commonly deployed in the field. Case report We highlight the case of a 25-year-old male who presented to the ambulance service with three self-inflicted neck wounds – one to each of the zones of the neck. The zone 2 wound had transected the internal jugular vein and also the ipsilateral vertebral artery, causing severe haemorrhage leading to hypovolaemic cardiac arrest in a remote farmhouse location. He was treated with a modified tamponade technique, employing the use of a Rapid Rhino 900™ epistaxis catheter, secured with sutures into the zone 2 wound prior to inflation. This resulted in complete haemostasis, which allowed the patient to be volume resuscitated, anaesthetised and flown by air ambulance to the regional trauma centre. His injuries were treated and his recovery was interrupted only by a transient Horner's syndrome. Discussion This report showcases the first time this modification of a well-known in-hospital technique was deployed, which proved life-saving in this case and could be of use to others. We discuss the importance of catheter tamponade techniques as opposed to direct packing, in particular for those who need to be transported either within, between or to the hospital. This is in contradistinction to other authors advocating direct packing as the mainstay of treatment.

The effectiveness of Foley catheter balloon tamponade versus expanding sponges and hemostatic granules for catastrophic penetrating groin hemorrhage with small skin defect: A comparative study in a live tissue porcine model with evaluation of a concise training program.

Prompt bleeding control in the prehospital phase is essential to improve survival from catastrophic junctional hemorrhage. This study aimed to compare the effectiveness and practicality of Foley catheter balloon tamponade (FCBT), Celox-A, and XSTAT for the treatment of catastrophic hemorrhage from penetrating groin injuries with a small skin defect in a live-tissue porcine model. In addition, this study aimed to determine whether a training program could train military personnel in application of these advanced bleeding control adjuncts. A standardized wound was created in 18 groins from 9 anesthetized swine. Eighteen military medics participated in the training program and performed a bleeding control procedure after randomization over the swine and test products and after transection of the femoral neurovascular bundle. Primary endpoints were bleeding control, time to bleeding control, rebleeding, blood loss, medic performance, and user product rating. No significant differences were found in vital signs and laboratory values between the groups. In the Celox-A group, 3/6 groins achieved hemorrhage control. This was 6/6 in the XSTAT and FCBT groups. XSTAT scored best on application time, time to obtain hemorrhage control, hemorrhage control score, and practicality. No significant differences were found between groups for rebleeding, amount of blood loss, and medic performance. Military medics had a significant higher preference for XSTAT over Celox-A. This was not significant for FCBT. All tested products proved effective in obtaining hemorrhage control. XSTAT has the highest effectivity and shortest application time for the treatment of catastrophic bleeding from nonpackable, penetrating junctional groin injuries with a small skin defect, compared with Celox-A and FCBT. XSTAT scored best on practicality. This study shows that our training curriculum can be used to train military medics with limited prior experience in the use of advanced bleeding control techniques for penetrating junctional groin injuries with small skin defect.

Foley Catheter Balloon Tamponade for Actively Bleeding Wounds Following Penetrating Neck Injury is an Effective Technique for Controlling Non-Compressible Junctional External Haemorrhage.

Thefoley catheter balloon tamponade (FCBT) has been widely employed in the management of trauma. This study reviews our cumulative experience with the use of FCBT in the management of patients presenting with a penetrating neck injury (PNI). A retrospective study was conducted at a major trauma centre in South Africa over a 9-year period from January 2012 to December 2020. All patients who presented with a PNI who had FCBT were included. A total of 1581 patients with a PNI were managed by our trauma centre, and 44 (3%) patients had an FCBT. Of the 44 cases of FCBT, stab wounds accounted for 93% (41/44) and the remaining 7% were for gunshot wounds. Seventy-five per cent of all FCBT (33/44) were inserted at a rural hospital prior to transfer to our trauma centre; the remaining 25% (11/44) were inserted in our resuscitation room. The success rate of FCBT was 80% (35/44), allowing further CT with angiography (CTA) to be performed. CTA findings were: 10/35 (29%) positive, 18/35 (51%) negative, and 7/35 (20%) equivocal. Fifteen patients required additional intervention (open surgery or endovascular intervention). The overall morbidity was 14% (6/44). Eighteen per cent required intensive care unit admission. The median length of stay was 1day. The overall mortality rate was 11% (5/44). FCBT is a simple and effective technique as an adjunct in the management of major haemorrhage from a PNI. In highly selective patients, it may also be used as definitive management.

An Update on Foley Catheter Balloon Tamponade for Penetrating Neck Injuries.

Foley catheter balloon tamponade (FCBT) for bleeding penetrating neck injuries (PNIs) is effective. This study aims to audit the technique and outcomes of FCBT. Adult patients with PNIs requiring FCBT presenting to Groote Schuur Hospital (GSH) within a 22-month study period were prospectively captured on an approved electronic registry. Retrospective analysis included demographics, major injuries, investigations, management and outcomes. During the study period, 628 patients with PNI were treated at GSH. In 95 patients (15.2%), FCBT was utilised. The majority were men (98%) with an average age of 27.9years. Most injuries were caused by stab wounds (90.5%). The majority of catheters (81.1%) were inserted prior to arrival at GSH. Computerised tomographic angiography (CTA) was done in 92.6% of patients, while eight patients (8.4%) required catheter-directed angiography. Six were performed for interventional endovascular management. Thirty-four arterial injuries were identified in 29 patients. Ongoing bleeding was noted in three patients, equating to a 97% success rate for haemorrhage control. Thirteen (13.7%) patients required neck exploration. Seventy-two (75.8%) patients without major arterial injury had removal of the catheter at 48-72h. Two of these bled on catheter removal. A total of 36 complications were documented in 28 patients (29.5%). There was one death due to uncontrolled haemorrhage from the neck wound. This large series highlights the ease of use of FCBT with high rates of success at haemorrhage control (97%). Venous injuries and minor arterial injuries are definitively managed with this technique.

Control of Hemorrhage in Liver Trauma

Background: Control of hemorrhage in major liver trauma constitutes an ongoing surgical challenge even in nowadays, as surgeons often face difficult situations in its management. The goal of this study was to analyze our experience in the control of hemorrhage in major liver trauma. Materials and methods: Our study was performed prospectively covering a period of time from January 2009 till December 2012. 173 patients with liver trauma were included in our study. Results: Temporary haemostasis maneuvers in the setting of urgent laparotomy consisted of: bimanual compression 13 patients (15.3%), Pringle maneuver 23 patients (27%), perihepatic packing 10 patients (11,8%), Foley catheter balloon tamponade 2 patients (2.4%), intrahepatic tamponade in penetrating trauma 4 patients (4.7%). Definitive haemostasis methods used in urgent laparotomy were: electro-coagulation of the liver injury 12 patients (14.1%), haemostasis and biliostasis followed by hepatic closure 41 patients (48.2%), haemostasis and biliostasis without hepatic closure 6 patients (7.1%), tamponade with a pedicled vascularized omental flap (pedicled omentum hepatorrhaphy) 7 patients (8.2%), anatomic liver resection 1 patient (1.2%), nonanatomic/atypical liver resection 7 patients (8.2%), right hepatic artery ligation 1 patient (1.2%). Surgical techniques in preplanned laparotomies consisted of: left hepatectomy 1 patient (16.6%), right hepatectomy 1 patient (16,6%), nonanatomic/atypical liver resections 4 patients (66.7%). The success of treatment was significantly related to the grade of liver injury (z= 5.2912, p=<0.00001), other concomitant abdominal organ injuries (z=4.0743, p=0.00005), amount of blood transfusion received (p=0.03207), and age (p=0.04944). Overall mortality rate was 13%. Conclusion: Perihepatic packing and performing the surgical intervention in two sessions has significantly improved survival rates in major liver trauma from our experience.

Management of Life-Threatening Hemorrhage from Maxillofacial Firearm Injuries Using Foley Catheter Balloon Tamponade.

The aim of this study is to evaluate the efficacy of Foley catheter in the management of hemorrhage from penetrating maxillofacial injuries in austere environment. This retrospective cohort study evaluated all penetrating head and neck trauma caused by firearm injuries reported to a military hospital at a forward aid location during 2015-2017. Foley catheter was used in the emergency management of bleeding in 11 cases. The effectiveness of this technique in controlling hemorrhage, its indication, contraindications, and complications has been explained. Out of 26 penetrating injuries received during the time period, 11 patients underwent Foley catheter balloon tamponade for the control of hemorrhage. Ten out of 11 patients responded adequately to balloon tamponade. One patient with a bullet lodged inside the neck underwent immediate surgical exploration for its removal and repair of internal jugular vein. No neurological deficits or complications were noted in any of the patients. Foley catheter balloon tamponade is very effective in managing hemorrhage from head and neck penetrating injuries. It significantly reduces the mortality by controlling bleeding from the major vessels especially in a combat environment.

Foley catheter balloon tamponade as a method of controlling iatrogenic pulmonary artery bleeding in redo thoracic surgery

Foley catheter balloon tamponade as a method of controlling iatrogenic pulmonary artery bleeding in redo thoracic surgery

Foley catheter balloon tamponade for penetrating neck injury management in military medicine: a case report

Background
 The use of Foley catheter balloon tamponade (FCBT) to address bleeding in the neck and maxillofacial area associated with penetrating trauma is widely accepted in South African Emergency Departments. Its efficacy has been documented in combat settings in the Iraqi area of operations, with significant improvement of patients survival rate. Despite such evidence, Special Operations Forces (SOF) medics training in these techniques is limited.
 Case
 We present the case of a partner forces (PF) soldier that received shrapnel injuries during combat operations, resulting in life-threatening haemorrhage from the neck.
 Conclusion
 The Special Operations Forces medics who treated this patient decided to apply FCBT to prevent re-bleeding during an unsupervised ground vehicle movement to the host nation (HN) definitive care. None of the SOF medics involved had received formal training in the technique prior to the case. Their only knowledge was based on anecdotal evidence and self-study of the literature. Due to the lack of accountability by admitting a patient into the HN chain of care, there is no information on the outcome other than the patient survived. FCBT was performed after the wound was packed ineffectively with hemostatic gauze resulting in an unstable clot that failed with patient movement resulting in a probable carotid artery Zone I I neck bleed. FCBT has the potential to be a quick and effective adjunct to control bleeding in the complicated narrow track wound patterns in the neck and maxillofacial area that are not amenable to manual pressure or hemostatic agents in combat trauma medicine.
 Keywords
 Foley; Foley catheter balloon tamponade; Special Operations forces Medics; Bleeding.

A Randomized Controlled Trial using iTClamp, Direct Pressure, and Balloon Catheter Tamponade to Control Neck Hemorrhage inaPerfused Human Cadaver Model.

Penetrating neck wounds are common in the civilian and military realms. Whether high or low velocity, they carry a substantial morbidity and mortality rate. We endeavored to ascertain whether the iTClamp is equivalent to direct manual pressure (DMP) and Foley catheter balloon tamponade (BCT). Using a perfused cadaver, a 4.5-cm wound was made in Zone 2 of the neck with a 1-cm carotid arteriotomy. Each of the hemorrhage control modalities was randomized and then applied to the wound separately. Time to apply the device and fluid loss with and without neck motion was recorded. There was no significant difference between the fluid loss/no movement (p>0.450) and fluid loss/movement (p>0.215) between BCT and iTClamp. There was significantly more fluid lost with DMP than iTClamp with no movement (p>0.000) and movement (p>0.000). The iTClamp was also significantly faster to apply than the Foley (p>0.000). The iTClamp and BCT were associated with significantly less fluid loss than DMP in a perfused cadaver model. The iTClamp required significantly less time to apply than the BCT. Both the iTClamp and the BCT were more effective than simple DMP. The iTClamp offers an additional option for managing hard-to-control bleeding in the neck.

Use of Foley's catheter balloon tamponade to control placental site bleeding resulting from major placenta previa during cesarean section

Aim: To evaluate the effect of 2-way Foley's catheter balloon tamponade on controlling immediate postpartum hemorrhage (PPH) in cases of major placenta previa during cesarean section (CS). Methods: We evaluated women with placenta previa from May to November 2015. Women with immediate PPH during CS due to major placenta previa were managed by 2-way Foley's catheter balloon tamponade when medical treatment failed, and before any surgical intervention. Results: Twenty patients, had major placenta previa, were delivered by elective CS and complicated by immediate PPH. Three placenta accreta patients (15%) underwent hysterectomy, 17 (85%) were managed by the 2-way Foley's catheter balloon tamponade. In two patients, Foley's catheter balloon failed to control bleeding and hysterectomy was done immediately. However, Foley's catheter balloon successfully treated the remaining 15 patients. The median bleeding during the operation was 1522.5 (± 619.29) ml. None of them presented complications related to this procedure or required any further invasive surgery. Conclusion: The 2-way Foley's catheter tamponade could be an option to control immediate postpartum hemorrhage resulting from major placenta previa during the cesarean section. This method is simple, cheap, nearly non-invasive and should be considered to reduce the risk of peripartum hysterectomy.

Improved Mortality from Penetrating Neck and Maxillofacial Trauma Using Foley Catheter Balloon Tamponade in Combat: Weppner J. J Trauma Acute Care Surg 2013;75:220–4

Improved Mortality from Penetrating Neck and Maxillofacial Trauma Using Foley Catheter Balloon Tamponade in Combat: Weppner J. J Trauma Acute Care Surg 2013;75:220–4

Improved mortality from penetrating neck and maxillofacial trauma using Foley catheter balloon tamponade in combat

The military medical community has promoted use of Foley catheter balloon tamponade in the initial management of vascular injury owing to neck or maxillofacial trauma. The aim of the study was to compare outcomes with Foley catheter tamponade with those obtained with traditional use of external pressure. This retrospective cohort study evaluated all cases of persistent bleeding caused by penetrating neck or maxillofacial trauma received at one forward aid station between December 2009 and October 2011. Cohorts included those who were treated with Foley catheter tamponade and those managed with external pressure. Which treatment option was applied depended solely on the availability of Foley catheters at the time. The effectiveness of each technique in controlling initial and delayed hemorrhage is described, and the impact on mortality is analyzed using the Student's t test and Fisher's exact test. Seventy-seven subjects met the inclusion criteria with 42 subjects in the Foley group and 35 subjects in the external pressure group. A statistically significant difference was found between the groups regarding delayed failure, experienced by three patients (7%) in the Foley group and nine patients (26%) in the external pressure group (p < 0.05). The difference in mortality, 5% (two patients) in the Foley tamponade group and 23% (eight patients) in the external pressure group, was statistically significant (p < 0.05). For penetrating neck and maxillofacial injuries in a combat environment, Foley catheter balloon tamponade significantly reduced mortality when compared with direct pressure techniques through its effect on preventing delayed bleeding.

Management of penetrating neck injuries

Routine surgical exploration after penetrating neck injury (PNI) leads to a large number of negative neck explorations and potential iatrogenic injury. Selective non-operative management (SNOM) of PNI is gaining favour. The present study assessed the feasibility of SNOM in PNI. Seventy-seven consecutive patients with PNI presenting to a tertiary trauma centre were included in this prospective study from September 2009 to December 2009. All patients were managed according to Advanced Trauma Life Support guidelines, and either underwent emergency surgery or were managed without surgery, based on clinical presentation and/or outcome of special investigations. Eight patients (10 per cent) were haemodynamically unstable at presentation. Foley catheter balloon tamponade (FCBT) was successful in stopping active bleeding in six of these patients, and diagnostic angiography revealed an arterial injury in five. The remaining 69 patients were managed using SNOM. Angiography or computed tomography was done in 41 patients (53 per cent), and showed arterial injury in 15. These injuries were treated surgically (7 patients), radiologically (stenting in 3) or conservatively. Contrast swallow and/or endoscopy were performed in 37 patients (48 per cent) for suspected oesophageal injury, but yielded no positive results. During follow-up no missed injuries were detected. FCBT was useful in patients with PNI and active bleeding. Stable patients should undergo additional investigation based on clinical findings only.

A Complication of Intracorporeal Use of Quikclot for Pelvic Hemorrhage

A 23-year-old Hispanic male sustained a single gun shot wound (GSW) to the left upper buttocks. He arrived to the Emergency Room in hemorrhagic shock with a systolic blood pressure of 73 and heart rate of 120. The patient had a patent airway, good breath sounds with adequate excursion but peripheral pulses were weak. He was able to move all extremities to command but was intermittently obtunded. There was a single GSW just above the left buttocks 5 cm lateral to the midline. The patient had diffuse abdominal tenderness and was in persistent shock. He was taken emergently to the operating room. No adjunct studies were performed in the Emergency Department except for the Focused Abdominal Sonography for Trauma examination that was positive for fluid. Approximately 2 L of blood was evacuated with lap pads at exploration. The bullet was retained in the low anterior abdominal wall on the ipsilateral side of the posterior GSW. There was continued active bleeding from deep within the pelvis. His aortic bifurcation and iliac veins were compressed but this did not arrest his bleeding. Venous bleeding continued from bony and soft tissue destruction. It was not well controlled with pelvic packing, gelfoam packing, foley catheter balloon tamponade, and iliac vein ligation. Bilateral internal iliac artery ligation was performed but the bleeding remained significant from a large bony defect. The patient continued to be hemodynamically unstable despite continued transfusions of red cells (15 units ultimately) and fresh frozen plasma. The decision for damage control laparotomy had been made early in the procedure but the pelvic bleeding eluded attempts at even reasonable surgical control for temporary closure and resuscitation. The left ureter had been identified and was found to be without apparent injury. Because the patient had continued bleeding that was not controlled by conventional means, and the patient’s clinical status was continuing to decline, one pack (1.75 oz.) of QuikClot, Absorbent Hemostatic Agent, was deposited in the large defect and packing was applied. This maneuver resulted in almost instant arrest of significant pelvic bleeding. There was a rapid improvement in hemodynamic parameters; however, the patient remained cold and coagulopathic. The remainder of the pelvis was packed and the uninjured left ureter was placed back in its normal position before the abdomen was temporarily closed and the patient transported to the Surgical Intensive Care Unit. The patient’s coagulopathy was corrected, there was no continued clinical bleeding and the patient’s physiologic parameters were more normal within the first 24 hours postoperatively. He was returned to the Operating Room where his packs were removed. There was only minimal bleeding noted. The remaining QuikClot was removed but there was a moderate amount of material left adherent to the surrounding tissues and deep within the pelvis. Quikclot was adherent to the ureter near the original injury site but it did appear intact. Tissues that were in contact with the material were viable. The patient did well postoperatively. He was transferred to the floor by postoperative day POD 2. He did not have evidence of bleeding and he complained only of left sided back and leg pain which was present preoperatively. He was tolerating a diet and was discharged on postoperative day 7. He was seen in a clinic visit and reported no other problems except for left sided back and leg pain as before. However, approximately 3 weeks postoperatively; he was evaluated and admitted for abdominal pain. Computed Tomography (CT) of the abdomen revealed left hydronephrosis and dilated ureter (Fig. 1). No ureteral extravasation was detected on CT. He was subsequently evaluated by urology and diagnosed with a ureteral injury with leak on anterograde cystourethrogram (Fig. 2). A nephrostomy tube was placed. Stent placement was attempted but was unsuccessful because of the size of the defect. Plans were made for elective operative repair. Two weeks later, he was evaluated emergently for abdominal pain and blood per his nephrostomy tube. He was found to have a hemoglobin of 7.2 g/dL (postoperative hemoglobin was 9.4 g/dL). He was found to be only in mild Submitted for publication August 21, 2006. Accepted for publication December 14, 2006. Copyright © 2009 by Lippincott Williams & Wilkins From the Department of Surgery, Division of Trauma/Surgical Critical Care (D.P., P.R.); and Department of Urology (S.C., C.B.), LAC USC Medical Center, Los Angeles, California. Address for reprints: Dr. David Plurad, MD, Department of Surgery, Division of Trauma/Surgical Critical Care, LAC USC Medical Center, 1200 North State Street, Los Angeles, CA; email: dsplurad@aol.com.

Foley Catheter Balloon Tamponade for Life‐threatening Hemorrhage in Penetrating Neck Trauma

Foley catheter (FC) balloon tamponade is a well-recognized technique employed to arrest hemorrhage from penetrating wounds. The aim of this study was to review our experience with this technique in penetrating neck wounds and to propose a management algorithm for patients with successful FC tamponade. A retrospective chart review (July 2004-June 2005 inclusive) was performed of patients identified from a prospectively collected penetrating neck injury computer database in whom FC balloon tamponade was used. The units' policy for penetrating neck injuries is one of selective nonoperative management. All patients with successful FC tamponade underwent angiography. A venous injury was diagnosed if angiography was normal. Ancillary tests were performed as indicated. Removal of the FC was performed in the OR. During the study period, 220 patients with penetrating neck injuries were admitted to our unit. Foley catheter balloon tamponade was used in 18 patients and was successful in 17 patients. Angiography was positive in 3 patients, all of whom underwent surgery. The FC was successfully removed in 13 patients at a mean of 72 (range 48-96) hours. One patient bled after removal of the catheter, mandating emergency surgery. Foley catheter balloon tamponade remains a useful adjunct in the management of selective patients with penetrating, bleeding neck wounds.

The management of hemorrhage from severe missile injuries using a Foley catheter balloon tamponade

The management of hemorrhage from severe missile injuries using a Foley catheter balloon tamponade

The management of hemorrhage from severe missile injuries using foley catheter balloon tamponade

Foley catheter tamponade is introduced as a method of arresting hemorrhage from maxillofacial wounds due to war missiles. Three cases representing severe casualties are presented and the technique described.