Intra-aortic Balloon Occlusion Research Articles

A Case of Hepatic Artery Aneurysm with Obstructive Jaundice, Resected and Reconstructed Safely Using an Intra-aortic Balloon Occlusion Catheter

A Case of Hepatic Artery Aneurysm with Obstructive Jaundice, Resected and Reconstructed Safely Using an Intra-aortic Balloon Occlusion Catheter

Intra-Aortic Balloon Occlusion Decreases Blood Loss During Open Reduction and Internal Fixation for Delayed Acetabular Fractures: A Retrospective Study of 43 Patients

Aim: It is difficult to treat delayed acetabular fractures due to massive blood loss during operation. Temporary balloon occlusion of the abdominal aorta was introduced into sacral tumor surgery to reduce intraoperative hemorrhage. The aim of this study was to investigate the effect of this method on reduction of intraoperative blood loss and analyze the complications of this technique in the treatment of delayed acetabular fracture. Methods: We retrospectively reviewed 43 patients with delayed acetabular fracture who were surgically treated through combined approaches. Nineteen patients underwent temporary balloon occlusion of the abdominal aorta; 10 patients had type B fracture and 9 patients had type C fracture according to the Müller AO classification. The remaining 24 patients were classified into a control group; 14 patients had type B fracture and 10 patients had type C fracture. Surgical time, intraoperative blood loss, blood transfusion, satisfactory reduction rate, and functional recovery were recorded and compared between two groups. Merle d'Aubigné and Postel scoring was applied to evaluate the patients. Results: The patients treated with intra-aortic balloon occlusion had a shorter surgical time (p = 0.008), less intraoperative blood loss (p = 0.005), and less transfused blood units (p = 0.001). No complications caused by balloon occlusion. No significant difference were observed in the outcomes and the complications related to acetabular fractures between two groups. Conclusions: Temporary balloon occlusion of the abdominal aorta is a reliable technique to control bleeding for the surgery of delayed acetabular fracture.

Usefulness of Continuous Renal Replacement Therapy During an Intra-Aortic Balloon Occlusion in Patients With Ruptured Abdominal Aortic Aneurysms

Usefulness of Continuous Renal Replacement Therapy During an Intra-Aortic Balloon Occlusion in Patients With Ruptured Abdominal Aortic Aneurysms

Intra-Aortic Balloon Occlusion for Pelvic and Sacrum Tumors: A Case Series

Background: The purpose of this study is to investigate feasibilities of intra-aortic balloon occlusion (IABO) for pelvic and sacrum tumors, focusing on the advantages and precautions of the technique. Methods: From January 2010 to December 2013, among all patients with sacrum or pelvic tumor, 46 underwent surgery adjuvant with IABO. We retrospectively reviewed the medical records of these patients, including characteristics, intraoperative hemorrhage, transfusion, serum potassium, arterial lactic acid, postoperative complication, tumor recurrence or metastasis at a follow-up of 28.2 months. Results: Balloons for 46 patients were successfully placed, and the average intraoperative hemorrhage was 1.8 (1.2-3.0) l. Intraoperatively, arterial lactic acid increased from baseline (1.69±0.68) mmol/l to (2.11±0.82) mmol/l (P=0.17) during occlusion and (3.50±2.70) mmol/l (P=0.02) after deflation. While serum potassium concentration showed a trend of increase, but the change was not significant. Application of the technique helped create a bloodless surgical field and shorten the operative time. 9 patients regained normal defecation, while 2 patients with preoperative numbness of perineum developed new onset urinary and fecal incontinence after surgery. Postoperatively, 5 patients developed wound infection, 1 patient developed lower limb weakness, and 1 patient developed cerebrospinal leak. During 28.2 months' follow-up, 5 recurrences and 2 metastases occurred. Conclusions: IABO might be a choice to reduce intraoperative bleeding, create a clear view of the anatomical structures, shorten the operative time and limit postoperative complication in resection of pelvic and sacrum tumor. Nevertheless, anesthesiologists and surgeons should be sensitive to hemodynamic parameters, electrolyte balance as well as acid-base balance during the procedure, especially after deflation of the balloon. Citation: Kai Sun, Yang-Fan Huo, Yong Xu, Feng-Jiang Zhang, Shui Yu, Zhen-Feng Zhou, et al. Intra-Aortic balloon occlusion for pelvic and sacrum tumors: a case series. J Anesth Perioper Med 2017; x: x-x. doi:10.24015/JAPM.2017.0029 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

大動脈閉塞バルーンとopen abdominal managementを併用し非解剖学的血行再建術を行った大動脈消化管瘻の1例(Intra–aortic balloon occulusion and extra–anatomical bypass with open abdominal management for aortoenteric fistula)

要旨一般に，大動脈消化管瘻は出血・感染コントロールに難渋する致死率の高い疾患である。今回，我々が行った大動脈閉塞バルーンカテーテルによる出血コントロール，open abdominal management（OAM）と非解剖学的血行再建術を併用した感染コントロールは有用であると考え報告する。症例は63歳の男性で，下血を主訴に救急搬送された。腹部造影CT検査で右感染性総腸骨動脈瘤の切迫破裂，S状結腸への穿破，骨盤内の膿瘍形成を認めた。大動脈閉塞バルーンカテーテルを挿入し中枢側遮断を行い，S状結腸部分切除，虫垂切除，右総腸骨動脈結紮・断端形成，左–右大腿動脈バイパス術を行った。術後はOAMとし，第2病日に瘤壁の可及的切除・デブリードメント，洗浄を行い，第3病日に人工肛門造設および閉腹術を行い，第33病日に退院した。本症例では大動脈閉塞バルーンカテーテル留置により，瘻孔からの出血コントロールを行うことで術中の視野確保，出血量の減少に有用であった。また可及的瘤壁の除去，3日間のOAMにより膿瘍壁のドレナージを繰り返し行い，非感染部位で血行再建を行うことで人工血管への感染も回避することができた。本症例を通して大動脈消化管瘻に対し大動脈閉塞バルーンカテーテル，OAMを用いた非解剖学的血行再建術は有用であると考えた。

Two Case of Intra-Aortic Balloon Occlusion by Different Vascular Approaches for Ruptured Abdominal Aortic Aneurysm

Two Case of Intra-Aortic Balloon Occlusion by Different Vascular Approaches for Ruptured Abdominal Aortic Aneurysm

Minimally invasive mitral valve repair using intra-aortic balloon occlusion and 3D HD camera system

Minimally invasive mitral valve repair using intra-aortic balloon occlusion and 3D HD camera system

Outcomes of abdominal trauma patients with hemorrhagic shock requiring emergency laparotomy: efficacy of intra-aortic balloon occlusion.

The aims of this study were to investigate outcomes of abdominal trauma in patients with hemorrhagic shock requiring emergency laparotomy and clarify the beneficial effects of intra-aortic balloon occlusion (IABO) for intra-abdominal hemorrhage in patients with critically uncontrollable hemorrhagic shock (CUHS). We reviewed 44 hemorrhagic shock patients who underwent emergency laparotomy for intra-abdominal hemorrhage over a 6-year period. Of these patients, we examined data for 19 subjects who underwent IABO during initial resuscitation to control massive intra-abdominal bleeding leading to CUHS. The average Injury Severity Score and probability of survival (Ps) of the 44 patients were 27.6 ± 15.4 and 0.735 ± 0.304, respectively, and the overall survival rate was 77.3%. The differences in the Glasgow Coma Scale, lactate level, prothrombin time - international normalized ratio, and Ps between the two groups (21 responders and 23 non-responders) were statistically significant (P < 0.05). Intra-aortic balloon occlusion was attempted in 19 of 23 patients (82.6%) with CUHS, and there were no statistically significant differences in presenting Glasgow Coma Scale, body temperature, lactate, prothrombin time - international normalized ratio, or Revised Trauma Score between the survivors (n = 12) and non-survivors (n = 7). The only significant differences between these two groups were observed in Injury Severity Score (P = 0.047) and Ps (P = 0.007). In all patients, the balloons were successfully placed in 8.1 ± 3.3 min in the thoracic aorta, and a significant increase in systolic blood pressure was observed immediately after IABO. The IABO procedure can be life-saving in the management of patients with CUHS arising from intra-abdominal hemorrhage, permitting transport to surgery.

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

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.

Abstract 16745: It Would be Possible to Rescue Traumatic Hemorrhagic Shock Patients Who Failed to Fluid Resuscitation (Fluid Non-responder) but Succeed in REBOA Resuscitation (REBOA/IABO Responder)

Introduction: Fluid resuscitation (FR) and massive transfusion protocol (MTP) are important initial strategies for traumatic hemorrhagic shock cases. But poor responded patients to them are difficult to rescue. In such cases, open aortic cross clamping or intra-aortic balloon occlusion (IABO) would be performed as a temporary hemostasis treatment. Recently, IABO for severe trauma has been named resuscitative endovascular balloon occlusion of the aorta (REBOA). But it is still unclear which case can be rescued with REBOA. So we studied the relationship between the responsiveness to FR and REBOA. Methods: Consecutive 46 traumatic hemorrhagic shock patients underwent REBOA at our ER for last 86 months were included. All of their FAST were positive and done FR and MTP as a first-line resuscitation. 10Fr or 7Fr IABO devices were inserted at supraphrenic level (zone I) and underwent fundamental hemostasis by operative management (OM) and/or transcatheter arterial embolization (TAE). They were sorted into responded group or non-responded group for REBOA. The primary end point was a recovery rate from the shock state within 48 hours. Secondary end points were a survival rate in 30th days and a rate of complications. Results: 26 transient or non-responded patients (Fluid Non-responder) responded for REBOA (REBOA Responder group). 20 Fluid Non-responders did not respond for REBOA (REBOA Non-responder group). There were no significant differences in ISS (REBOA Responder vs. Non-responder: 45.8+/-15.2 vs. 54.8+/-22.3), amount of total fluid (7187+/-5782ml vs. 6772+/-4851) and total blood transfusion (4816+/-3006ml vs. 5080+/-3330), required time to occlude after arriving ER (25.3+/-12.6min vs. 19.4+/-9.8) and total occlusion time (76.4+/-66.5min vs. 92.7+/-34.4). There was significant difference in the changes of systolic blood pressure before and after of REBOA (59.3+/-25.7mmHg vs. 38.3+/-39.4, p=0.04). A recovery rate from shock state was 65%(12/26) vs. 0%(0/20) (p&lt;0.01) and a survival rate was 14/26(54%) vs. 0/20(0%) (p&lt;0.01). One complication occurred in REBOA Responder group but was not lethal. Conclusions: It would be necessary to recognize that Fluid Non-responder but REBOA Responder with traumatic hemorrhagic shock could be possible to rescue.

Intra-aortic balloon occlusion without fluoroscopy for life-threating post-partum hemorrhage

Abstract The use of intra-aortic balloon occlusion (IABO) could be effective in achieving the quick control of bleeding in emergency settings and in supporting the provision of safe radical treatment through resuscitative endovascular balloon occlusion of the aorta (REBOA). We herein report our experience of a patient with life-threatening postpartum hemorrhage after cesarean section who was successfully treated by hysterectomy with IABO without fluoroscopy. We believe that this procedure is very useful and safe, and that it should be considered as one of methods for controlling bleeding in patients with life-threatening postpartum hemorrhage.

Risk Factors of Surgical Site Infection after Acetabular Fracture Surgery.

Surgical site infections (SSI) after acetabular fracture surgery are uncommon but devastating. It is still unknown which risk factors contribute to SSI. The primary objective of this study is to investigate the risk factors of SSI after acetabular fracture surgery. A total of 338 patients who underwent the acetabular fracture surgical procedure were studied retrospectively. Post-operative SSI developed in 16 patients. From the medical record, age, gender, body mass index (BMI), Injury Severity Score (ISS), active smokers, diabetes mellitus, causes of fracture, associated injuries, classification of the acetabular fracture, time from injury to operation, operative approaches, use of the Intra-Aortic Balloon Occlusion (IABO), operative time, surgical blood loss, and days in the intensive care unit (ICU) were extracted. Univariate and multivariable analysis were performed to determine the association between risk factors and infection. There were 10 males and six females in the infected group. According to the univariate analysis, the patients in whom SSI developed were more obese (higher BMI), more severely injured in terms of ISS, and had longer ICU stays. The operative time was longer, and estimated blood loss was larger in the infected group. Associated injuries such as Morel-Lavallée lesion, abdominal trauma, and urinary tract trauma were common in the infected group. Combined approaches and IABO were more commonly applied in the infected group. Multivariate analysis indicated that the operative time, Morel-Lavallée lesion, and abdominal trauma are the independent risk factors for SSI. To reduce the incidence of SSI in patients with acetabular fractures, special attention should be paid to the obese patients, Morel-Lavallée lesion, and concomitant abdominal trauma. Keeping the operative time short also reduces the risk of SSI. It is important to perform surgical intervention immediately after the infection occurs.

Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock.

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.

出血性ショックを伴う腹部刺創に対し，IABO併用下のDCS後に下腿コンパートメント症候群を呈した1例(A complicated case of lower leg compartment syndrome after damage control surgery (DCS) with intra–aortic balloon occlusion (IABO) for severe abdominal stab injury under severe hemorrhagic shock)

要旨腹部刺創による出血性ショック症例に対して，大動脈閉塞バルーンカテーテル（intra–aortic balloon occlusion; IABO），Damage Control Surgery（以下DCS）を施行後，下腿コンパートメント症候群（Lower Leg Compartment Syndrome; LLCS）を呈した1例を経験したので報告する。症例は43歳男性で，腹部を刺し倒れているところを発見され，当院に救急搬送された。来院時ショック状態を呈し，腹部超音波検査にてMorison窩に液体貯留を認め，外表上，腹部2ヶ所の刺創より腸管脱出を認めた。初期輸液に反応せず，気管挿管及び，右大腿動脈からIABOを挿入し，濃厚赤血球の急速輸血を開始した。来院から約35分で緊急開腹術を施行した。開腹すると，複数箇所の腸管損傷を認め，刺入創先端は後腹膜に達していた。可及的な腸管切除後，後腹膜部位からの出血のコントロールが困難となり，deadly triadを認めたため，ガーゼパッキングを実施して速やかに閉腹した。初回術後，Intra–abdominal pressure（以下IAP）は最高値40mmHgを示したため，abdominal compartment syndrome（以下ACS）と判断し，術後約24時間でsecond look operationを施行し，腸管吻合を実施した後，閉腹した。その後IAPは16mmHgまで速やかに改善した。しかし初回緊急手術から約48時間後，右下腿の色調変化と，下腿コンパートメント圧の上昇（最大80mmHg）を認めた。血清クレアチニンキナーゼ（CK）は62100IU/Lまで上昇した。右LLCSと診断し，減張切開を行い，速やかにコンパートメント圧は低下した。しかし一部筋壊死を認めたため，術後13日目に，壊死筋部のデブリードマンを要した。術後経過は良好で，第53病日に独歩退院した。本症例におけるLLCSの成因として，IABOやDCSに伴う下腿虚血・還流障害が一因と考えられた。

大動脈閉塞バルーン併用下の手術が有効であった腹部外傷の3例

大動脈閉塞バルーン併用下の手術が有効であった腹部外傷の3例

Dexmedetomidine improves the histological and neurological outcomes 48 h after transient spinal ischemia in rats

Dexmedetomidine, an α2 adrenoceptor agonist, provides neuroprotection against various cerebral ischemia models through its anti-apoptotic effects. Dexmedetomidine also improves paraplegia induced by intrathecal morphine after short-term spinal ischemia. However, there are no reports regarding dexmedetomidine׳s ability to provide neuroprotection solely against transient spinal ischemia. We investigated whether dexmedetomidine would provide spinal protection following transient spinal ischemia in rats. Adult male Sprague Dawley rats were randomly assigned to one of the following five groups: (1) intravenous infusion of 0.9% NaCl at the rate of 0.5mL/h (control), (2) dexmedetomidine 0.1µg/kg/h, (3) dexmedetomidine 1µg/kg/h, (4) dexmedetomidine 10µg/kg/h, or (5) intravenous infusion of 0.9% NaCl without spinal ischemia (sham). The rats received saline solution or dexmedetomidine from 30min before spinal cord ischemia to 48h after ischemia. Spinal cord ischemia was induced by intraaortic balloon occlusion combined with proximal arterial hypotension for 10min. Ischemic injury was assessed by neurological deficit scores and the number of viable motor nerve cells in the anterior spinal cord at 48h after reperfusion. Neurological deficit scores in the dexmedetomidine-treated rats were significantly lower than the scores in the control group at 24 and 48h after ischemia (P<0.05). The number of viable motor nerve cells was significantly larger in the dexmedetomidine-treated rats than in the control rats (P<0.05), but the number of motor nerve cells in the dexmedetomidine group was significantly smaller than the sham group. Our results indicate that the continuous administration of dexmedetomidine improves neurological and histological outcomes 48h after transient spinal ischemia in rats.

Resuscitative Thoracotomy: An Update

Resuscitative thoracotomy is a heroic procedure that may offer the only survival hope for trauma patients in extremis. However, this operation has been the subject of much debate and its use, feasibility, outcomes, and cost are being continuously re-evaluated. This is a review of the most current (after 2000) literature on resuscitative thoracotomy, based on computer database searches for studies on resuscitative thoracotomy, emergency department thoracotomy, and emergency thoracotomy. Studies were selected for inclusion in this review based on their relevance and contribution to our understanding of resuscitative thoracotomy. A total of 37 studies were included, and the following resuscitative thoracotomy-related topics were critically discussed: indications, biochemical profile, long-term outcome, organ donation, pre-hospital use, military use, international aspects, intra-aortic balloon occlusion, suspended animation, and cost and occupational exposure. This review demonstrates that the indications for resuscitative thoracotomy become clearer and that new information is available regarding its use in the pre-hospital urban environment and military settings. Furthermore, it points to new strategies to supplement resuscitative thoracotomy including intra-aortic balloon occlusion and suspended animation. Finally, it sheds light on the long-term outcomes, organ donation, and cost and occupational exposure following resuscitative thoracotomy.

Dexmedetomidine Ameliorates Histological and Neurological Outcomes after Transient Spinal Ischemia in Rats

Aims: Dexmedetomidine, anα2adrenergicagonist, provides neuroprotection in various cerebral ischemia models and against anesthesia-related neurotoxicity. Dexmedetomidine also improves paraplegia induced by intrathecal morphine after short-term spinal ischemia. In this preliminary study, we investigated whether dexmedetomidine provides spinal protection against transient spinal ischemia in rats. Methodology: Adult male Sprague-Dawley rats were randomly divided into the following 3 groups: 1) intravenous infusion of 0.9% NaCl at a rate of 0.5 mL/h (control), 2) dexmedetomidine 1 μg/kg/h, and 3) intravenous infusion of 0.9% NaCl without spinal ischemia (sham). The rats received saline solution or dexmedetomidine 30 min before spinal cord ischemia and for 24 h. Spinal cord ischemia was induced by intra-aortic balloon occlusion combined with proximal arterial hypotension for 10 min. Ischemic injury was assessed by the neurological deficit score and by the number of viable motor nerve cells in the anterior spinal cord at 24 h of reperfusion. Results: The neurological deficit score was significantly lower in the dexmedetomidine group compared to the control group (p< 0.05). The number of viable motor nerve cells in the dexmedetomidine group was significantly greater than was that in the control group (p< 0.05), but was lower than was that in the sham group. Short Research Article British Journal of Medicine & Medical Research, 4(33): 5238-5247, 2014 5239 Conclusion: Our findings suggest that continuous administration of dexmedetomidine ameliorates short-term neurological and histological outcomes induced by transient spinal cord ischemia and reperfusion in rats; thus, dexmedetomidine appears to protect the spinal as well as the brain.

Two Cases of Blunt Abdominal Trauma Treated by Pre-operative Intra-aortic Balloon Occlusion (IABO)

Two Cases of Blunt Abdominal Trauma Treated by Pre-operative Intra-aortic Balloon Occlusion (IABO)

Efficacy of Intra-Aortic Balloon Occlusion for Treatment in Blunt Trauma Patients With Shock

Intra-aortic balloon occlusion (IABO) is sometimes used in Japan and Europe to control bleeding and stabilize hemorrhagic shock when definitive surgical management is delayed. IABO devices are placed by emergency physicians through the femoral artery to “cross-clamp” the aorta. There is limited evidence of IABO treatment efficacy and most evidence comes from case series or small sample size retrospective studies. We used trauma registry data from Japan to measure the effect of IABO placement on mortality from blunt trauma in adults.