Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challenges
Background The application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma resuscitation, including for profound shock and cardiac arrest, has gained prominence. This study aimed to determine the characteristics of patients who were transported to the trauma resuscitat...
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BMJ Publishing Group
2024-07-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001264.full |
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| author | Tongporn Wannatoop Peerayuht Phuangphung Tanut Sornmanapong |
| author_facet | Tongporn Wannatoop Peerayuht Phuangphung Tanut Sornmanapong |
| author_sort | Tongporn Wannatoop |
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| description | Background The application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma resuscitation, including for profound shock and cardiac arrest, has gained prominence. This study aimed to determine the characteristics of patients who were transported to the trauma resuscitation area (the TTRA group) and those who died at the scene (the DAS group), aiming to identify suitable REBOA candidates and critical contraindications.Methods A descriptive research design was used. We retrospectively reviewed 1158 adult trauma patients managed at a level I trauma center in 2020 and 2021. The TTRA group comprised 215 patients who, upon arrival at the trauma resuscitation area, either presented with a systolic blood pressure under 90 mm Hg or were in traumatic cardiac arrest but still exhibited signs of life. The study included patients directly transferred from incident scenes to the forensic unit. The DAS group comprised 434 individuals who were declared deceased at the scene of major trauma. REBOA indications were considered for two purposes: anatomic bleeding control for sources below the diaphragm to the groin, and circulatory restoration in patients with profound shock or cardiac arrest. Absolute REBOA contraindications were assessed, particularly for aortic and cardiac injuries, with or without cardiac tamponade.Results Predominantly male, the cohort largely consisted of motorcycle accident victims. The median Injury Severity Score was 41 (range 1–75). Within the TTRA group, the prospective applicability of REBOA was 52.6%, with a prevalence of major hemorrhagic sources from the abdomen to the groin of 38.6% and substantial intra-abdominal bleeding of 28.8%. The DAS group exhibited a prevalence of major hemorrhagic sources from the abdomen to the groin of 50.2%, and substantial intra-abdominal bleeding of 41.2%. In terms of REBOA contraindications, the DAS group demonstrated a greater prevalence of overall contraindications of 25.8%, aortic injuries 17.3%, and concomitant conditions of 16.4%. In the TTRA group, the rates of overall contraindications, aortic injury, and comorbid conditions were 12.6%, 4.2%, and 8.8, respectively. Cardiac injuries were noted in approximately 10% of patients in both groups.Conclusions This investigation underscores the potential benefits of REBOA in the management of major trauma patients. The prevalence of bleeding sources suitable for REBOA was high in both the TTRA and DAS groups. However, a significant number of patients in both groups also had contraindications to the procedure. These outcomes highlight the critical importance of enhanced training in patient assessment to ensure the safe and effective deployment of REBOA, particularly in resource-limited environments such as ongoing trauma resuscitation and prehospital care.Level of evidence Level III. |
| format | Article |
| id | doaj-art-69ae9a4db6644402934ea4443242d090 |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | BMJ Publishing Group |
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| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-69ae9a4db6644402934ea4443242d0902025-01-24T10:10:10ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-07-019110.1136/tsaco-2023-001264Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challengesTongporn Wannatoop0Peerayuht Phuangphung1Tanut Sornmanapong2Department of Surgery, Mahidol University, Faculty of Medicine Siriraj Hospital, Bangkok, ThailandDepartment of Forensic Medicine, Mahidol University, Faculty of Medicine Siriraj Hospital, Bangkok, ThailandDepartment of Surgery, Mahidol University, Faculty of Medicine Siriraj Hospital, Bangkok, ThailandBackground The application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma resuscitation, including for profound shock and cardiac arrest, has gained prominence. This study aimed to determine the characteristics of patients who were transported to the trauma resuscitation area (the TTRA group) and those who died at the scene (the DAS group), aiming to identify suitable REBOA candidates and critical contraindications.Methods A descriptive research design was used. We retrospectively reviewed 1158 adult trauma patients managed at a level I trauma center in 2020 and 2021. The TTRA group comprised 215 patients who, upon arrival at the trauma resuscitation area, either presented with a systolic blood pressure under 90 mm Hg or were in traumatic cardiac arrest but still exhibited signs of life. The study included patients directly transferred from incident scenes to the forensic unit. The DAS group comprised 434 individuals who were declared deceased at the scene of major trauma. REBOA indications were considered for two purposes: anatomic bleeding control for sources below the diaphragm to the groin, and circulatory restoration in patients with profound shock or cardiac arrest. Absolute REBOA contraindications were assessed, particularly for aortic and cardiac injuries, with or without cardiac tamponade.Results Predominantly male, the cohort largely consisted of motorcycle accident victims. The median Injury Severity Score was 41 (range 1–75). Within the TTRA group, the prospective applicability of REBOA was 52.6%, with a prevalence of major hemorrhagic sources from the abdomen to the groin of 38.6% and substantial intra-abdominal bleeding of 28.8%. The DAS group exhibited a prevalence of major hemorrhagic sources from the abdomen to the groin of 50.2%, and substantial intra-abdominal bleeding of 41.2%. In terms of REBOA contraindications, the DAS group demonstrated a greater prevalence of overall contraindications of 25.8%, aortic injuries 17.3%, and concomitant conditions of 16.4%. In the TTRA group, the rates of overall contraindications, aortic injury, and comorbid conditions were 12.6%, 4.2%, and 8.8, respectively. Cardiac injuries were noted in approximately 10% of patients in both groups.Conclusions This investigation underscores the potential benefits of REBOA in the management of major trauma patients. The prevalence of bleeding sources suitable for REBOA was high in both the TTRA and DAS groups. However, a significant number of patients in both groups also had contraindications to the procedure. These outcomes highlight the critical importance of enhanced training in patient assessment to ensure the safe and effective deployment of REBOA, particularly in resource-limited environments such as ongoing trauma resuscitation and prehospital care.Level of evidence Level III.https://tsaco.bmj.com/content/9/1/e001264.full |
| spellingShingle | Tongporn Wannatoop Peerayuht Phuangphung Tanut Sornmanapong Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challenges Trauma Surgery & Acute Care Open |
| title | Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challenges |
| title_full | Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challenges |
| title_fullStr | Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challenges |
| title_full_unstemmed | Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challenges |
| title_short | Resuscitative endovascular balloon occlusion of the aorta in trauma management: a comprehensive study of clinical indications and challenges |
| title_sort | resuscitative endovascular balloon occlusion of the aorta in trauma management a comprehensive study of clinical indications and challenges |
| url | https://tsaco.bmj.com/content/9/1/e001264.full |
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