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Eur J Emerg Med. 2018 Oct;25(5):348-354. doi: 10.1097/MEJ.0000000000000466.

Partial occlusion, conversion from thoracotomy, undelayed but shorter occlusion: resuscitative endovascular balloon occlusion of the aorta strategy in Japan.

Author information

1
R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA.
2
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba.
3
Department of Emergency and Critical Care Medicine, School of Medicine, St. Marianna University, Kawasaki.
4
Department of Radiology, School of Medicine, Teikyo University, Tokyo.
5
Senshu Trauma and Critical Care Center, Rinku General Medical Center, Osaka.
6
Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.

Abstract

INTRODUCTION:

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable alternative to resuscitative thoracotomy (RT) in refractory hemorrhagic patients. We evaluated REBOA strategies using Japanese multi-institutional data.

PATIENTS AND METHODS:

The DIRECT-IABO investigators registered trauma patients requiring REBOA from 18 hospitals. Patients' characteristics, outcomes, and time in initial treatment were collected and analyzed.

RESULTS:

From August 2011 to December 2015, 106 trauma patients were analyzed. The majority of patients were men (67%) (median BMI of 22 kg/m, 96% blunt injured). REBOA occurred in the field (1.9%, all survived >30 days), emergency department (75%), angiography suite (17%), and operating room (1.9%). Initial deployment was at zone I in 93% and partial occlusion in 70% of cases. RT and REBOA were combined in 30 patients (RT+REBOA group) who showed significantly higher injury severity score (44 vs. 36, P=0.001) and chest abbreviated injury scale (4 vs. 3; P<0.001) than the REBOA-alone group (n=76). Frequent cardiopulmonary resuscitation (73%), longer prothrombin time-international normalised ratio, lower pH, and higher lactate were observed in the RT+REBOA. Among 24 h nonsurvivors (n=30) of the REBOA alone, preocclusion systolic blood pressure was lower (43 vs. 72 mmHg; P=0.002), indicating impending cardiac arrest, and duration of occlusion was longer (60 vs. 31 min; P=0.010). In the RT+REBOA (n=30), six survived beyond 24 h, three beyond 30 days, and achieved survival discharge.

CONCLUSION:

Partial occlusion was performed in 70% of patients. Undelayed deployment of REBOA without presenting impending cardiac arrest with shorter balloon occlusion (<30 min at zone I with partial occlusion) might be related to successful hemodynamic stabilization and improved survival. Further evaluation should be performed prospectively.

PMID:
28328730
DOI:
10.1097/MEJ.0000000000000466
[Indexed for MEDLINE]

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