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 percent) were men and their median age was 45 years. All had severe injury with blunt trauma being the most common cause.
Thirty-eight (52 percent) REBOAs were inserted blindly. Catheters sizes 7- and 10Fr were used in 67 percent of patients. Most of these (82 percent) were inserted by emergency physicians, trauma surgeons and vascular surgeons and 65 percent 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 percent), respiratory failure (17.5 percent) and renal failure (11.1 percent).
Overall, 49 percent of ITCA patients remained hypotensive following REBOA inflation, but 20 percent 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 percent. 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.