Resuscitative endovascular balloon occlusion of the aorta: Difference between revisions
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==Overview== | ==Overview== | ||
[[File:Aorta segments.jpg|thumb|Aortic segments.]] | |||
[[File:Aorta branches.jpg|thumb|Branches of the aorta.]] | |||
*Abbreviation: REBOA | |||
*Type of catheter based hemorrhage control | |||
*Hemorrhage is a leading cause of trauma-related mortality<ref>Tieu BH et al. Coagulopathy: Its pathophysiology and treatment in the injured patient. World J Surg. 2007;31:1055–64</ref> | *Hemorrhage is a leading cause of trauma-related mortality<ref>Tieu BH et al. Coagulopathy: Its pathophysiology and treatment in the injured patient. World J Surg. 2007;31:1055–64</ref> | ||
*REBOA has been proposed as a less invasive alternative to resuscitative thoracotomy | *REBOA has been proposed as a less invasive alternative to resuscitative thoracotomy | ||
*Research is ongoing, but has yet to demonstrate a mortality benefit<ref name="Morrison">Morrison JJ, Galgon RE, Jansen JO, et al. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg. 2016 Feb;80(2):324-34.</ref> | *Research is ongoing, but has yet to demonstrate a mortality benefit<ref name="Morrison">Morrison JJ, Galgon RE, Jansen JO, et al. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg. 2016 Feb;80(2):324-34.</ref> | ||
**Retrospective case-control analysis found higher mortality for REBOA patients compared to similar cohort, higher complication rates of AKI and lower limb amputation <ref> Bellal Joseph, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508 </ref> | |||
[[File:Reboa.jpg|thumb|]] | |||
===REBOA Zones=== | ===REBOA Zones=== | ||
*'''Zone 1:''' From left subclavian artery to the celiac trunk | *'''Zone 1:''' From left subclavian artery to the celiac trunk | ||
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==Indications== | ==Indications== | ||
*Non-compressible | *Non-compressible [[hemorrhage]] below the diaphragm in the abdomen, pelvis or retroperitoneum <ref>Qasim, Zaffer, et al. “Resuscitative endovascular balloon occlusion of the aorta.” Resuscitation 96 (2015): 275-279.</ref> | ||
*Traumatic cardiac arrest | *Positive [[FAST]] | ||
*[[Pelvic fracture]] with negative FAST | |||
*[[Traumatic cardiac arrest]] ''without'' aortic dissection or pericardial tamponade | |||
*Suspected traumatic abdominal hemorrhage (Zone I REBOA) | |||
*Blunt pelvic injury or groin junctional hemorrhage (Zone III REBOA) | |||
==Contraindications== | ==Contraindications== | ||
* | *Age ≤18 or ≥70y | ||
*Atraumatic [[cardiac arrest]] | |||
*Proximal [[traumatic aortic rupture|traumatic aortic dissection]] | |||
*Proximal [[aortic dissection]] | |||
*[[Cardiac tamponade]] | |||
==Equipment Needed== | ==Equipment Needed== | ||
*Ultrasound | |||
*REBOA Kit | |||
==Procedure== | ==Procedure== | ||
#Access the common femoral artery and place a standard 18G arterial line | #Immediately perform a [[FAST]] exam to assess for [[pericardial tamponade]] (contraindication) | ||
#Access the '''common femoral artery''' under ultarsound guidance and place a standard 18G arterial line | |||
#Pass a 260cm guidewire through that arterial line up to the level of the left subclavian | #Pass a 260cm guidewire through that arterial line up to the level of the left subclavian | ||
#Obtain a chest Xray if feasible to confirm the position of the guidewire | #Obtain a chest Xray if feasible to confirm the position of the guidewire | ||
#Estimate length of catheter insertion based on desired location and external landmarks | #Estimate length of catheter insertion based on desired location and external landmarks | ||
#*''Zone 1: | #*''Zone 1: Xiphoid process for Zone 1 (aprox 50cm)'' | ||
#*''Zone 3: umbilicus for Zone 3'' | #*''Zone 3: umbilicus for Zone 3 (approx 40cm)'' | ||
#Place the REBOA 12 French arterial line introducer sheath | #Place the REBOA 12 French arterial line introducer sheath | ||
#Advance the catheter over the wire through the sheath, then inflate the balloon with saline in the desired zone | #Advance the catheter over the wire through the sheath, then inflate the balloon with saline in the desired zone | ||
#*Resistance will be felt as the balloon inflates against the wall of the aorta and '''blood pressure will increase substantially if successful''' | #*Resistance will be felt as the balloon inflates against the wall of the aorta and '''blood pressure will increase substantially if successful''' | ||
==Complications== | ==Complications== | ||
*Failure to access the common femoral artery | |||
==See Also== | ==See Also== | ||
*[[Thoracotomy]] | |||
*[[Pericardial tamponade]] | |||
*[[Thoracic trauma]] | |||
*[[Abdominal trauma]] | |||
*[[Arterial line]] | |||
==External Links== | ==External Links== | ||
*[http://blog.ercast.org/reboa/ REBOA 101 ERCast] | *[http://blog.ercast.org/reboa/ REBOA 101 ERCast] | ||
===Videos=== | |||
{{#widget:YouTube|id=b-s2cpuHq9k}} | |||
==References== | ==References== | ||
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[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Critical Care]] | [[Category:Critical Care]] | ||
[[category:Trauma]] | |||
Latest revision as of 15:32, 29 June 2021
Overview
- Abbreviation: REBOA
- Type of catheter based hemorrhage control
- Hemorrhage is a leading cause of trauma-related mortality[1]
- REBOA has been proposed as a less invasive alternative to resuscitative thoracotomy
- Research is ongoing, but has yet to demonstrate a mortality benefit[2]
- Retrospective case-control analysis found higher mortality for REBOA patients compared to similar cohort, higher complication rates of AKI and lower limb amputation [3]
REBOA Zones
- Zone 1: From left subclavian artery to the celiac trunk
- Zone 2: From the celiac trunk to the lowest renal artery
- Zone 2 is an unused zone because if of difficulty in occluding the bleeding vessel at this aortic location
- Zone 3: From lowest renal artery to the aortic bifurcation
Indications
- Non-compressible hemorrhage below the diaphragm in the abdomen, pelvis or retroperitoneum [4]
- Positive FAST
- Pelvic fracture with negative FAST
- Traumatic cardiac arrest without aortic dissection or pericardial tamponade
- Suspected traumatic abdominal hemorrhage (Zone I REBOA)
- Blunt pelvic injury or groin junctional hemorrhage (Zone III REBOA)
Contraindications
- Age ≤18 or ≥70y
- Atraumatic cardiac arrest
- Proximal traumatic aortic dissection
- Proximal aortic dissection
- Cardiac tamponade
Equipment Needed
- Ultrasound
- REBOA Kit
Procedure
- Immediately perform a FAST exam to assess for pericardial tamponade (contraindication)
- Access the common femoral artery under ultarsound guidance and place a standard 18G arterial line
- Pass a 260cm guidewire through that arterial line up to the level of the left subclavian
- Obtain a chest Xray if feasible to confirm the position of the guidewire
- Estimate length of catheter insertion based on desired location and external landmarks
- Zone 1: Xiphoid process for Zone 1 (aprox 50cm)
- Zone 3: umbilicus for Zone 3 (approx 40cm)
- Place the REBOA 12 French arterial line introducer sheath
- Advance the catheter over the wire through the sheath, then inflate the balloon with saline in the desired zone
- Resistance will be felt as the balloon inflates against the wall of the aorta and blood pressure will increase substantially if successful
Complications
- Failure to access the common femoral artery
See Also
External Links
Videos
{{#widget:YouTube|id=b-s2cpuHq9k}}
References
- ↑ Tieu BH et al. Coagulopathy: Its pathophysiology and treatment in the injured patient. World J Surg. 2007;31:1055–64
- ↑ Morrison JJ, Galgon RE, Jansen JO, et al. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg. 2016 Feb;80(2):324-34.
- ↑ Bellal Joseph, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508
- ↑ Qasim, Zaffer, et al. “Resuscitative endovascular balloon occlusion of the aorta.” Resuscitation 96 (2015): 275-279.