1/11/2020 https://www.medscape.

com/viewarticle/923514_print

www.medscape.com

REBOA May Be Helpful for Some Trauma Patients With Massive

Bleeding
By Reuters Staff

January 09, 2020

NEW YORK (Reuters Health) - Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be helpful in
certain patients with traumatic hemorrhagic shock and impending traumatic cardiac arrest (ITCA), according to an
international group of researchers.

By temporarily stabilizing the hemodynamics of exsanguinating patients, it's possible that REBOA could replace
resuscitative thoracotomy (RT), Dr. David Thomas McGreevy of Oerebro University Hospital, in Sweden, and colleagues
note in a paper in Shock.

The aim of RT is to address intra-thoracic injuries, perform open CPR and compress the thoracic aorta while resuscitating
the patient with blood products. In contrast to RT, they authors say, REBOA is a minimally invasive technique for occluding
the thoracic aorta and providing proximal control of abdominal bleeding and should therefore be considered in trauma
patients in shock.

It's known that REBOA can improve systolic blood pressure (SBP) in patients in hypovolemic shock, but the technique has
not been studied in ITCA patients.

To do so, the researchers examined data on 74 such patients from 16 centers. Most (73%) were men and their median age
was 45 years. All had severe injury with blunt trauma being the most common cause.

Thirty-eight (52%) REBOAs were inserted blindly. Catheters sizes 7- and 10Fr were used in 67% of patients. Most of these
(82%) were inserted by emergency physicians, trauma surgeons and vascular surgeons and 65% were inflated for more
than half an hour.

SBP significantly improved following the inflation of the REBOA, going from a median of 0 mmHg to a median of 90 mmHg.
None of the balloons ruptured but common complications included multi-organ failure (47.6%), respiratory failure (17.5%)
and renal failure (11.1%).

Overall, 49% of ITCA patients remained hypotensive following REBOA inflation, but 20% were stable.

"Permissive hypotension, reducing blood loss and preventing cardiac arrest," say the researchers, "offers a survival benefit
and gives the medical team more time to achieve definitive treatment."

The survival rate was 36.6%. Those who died were significantly older, had more CPR in the emergency department, were
hypothermic and had significantly lower arterial pH.

Indications for the use of REBOA remain debatable, the researchers note, but the high survival rate "despite the majority of
patients being subjected to blunt trauma, justifies resuscitation efforts with the use of REBOA in patients with ITCA."

Dr. McGreevy did not respond to requests for comment.

SOURCE: https://bit.ly/2R0Jikw Shock, online December 16, 2019.

Reuters Health Information © 2020

Cite this: REBOA May Be Helpful for Some Trauma Patients With Massive Bleeding - Medscape - Jan 08, 2020.

https://www.medscape.com/viewarticle/923514_print 1/1