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Resuscitation. 2018 Dec 27;135:6-13. doi: 10.1016/j.resuscitation.2018.12.018. [Epub ahead of print]

Pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for exsanguinating pelvic haemorrhage.

Author information

1
Bart's Health NHS Trust, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; London's Air Ambulance, The Helipad, 17th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; NHS Lothian, Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom. Electronic address: r.lendrum@nhs.net.
2
Bart's Health NHS Trust, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; London's Air Ambulance, The Helipad, 17th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; Centre for Trauma Sciences, Queen Mary University of London, Research Office Ward 12D, 12th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.
3
The Institute of Pre-Hospital Care at London's Air Ambulance, The Helipad, 17th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.
4
Centre for Trauma Sciences, Queen Mary University of London, Research Office Ward 12D, 12th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
5
Bart's Health NHS Trust, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; Centre for Trauma Sciences, Queen Mary University of London, Research Office Ward 12D, 12th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.
6
Bart's Health NHS Trust, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; London's Air Ambulance, The Helipad, 17th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; The Institute of Pre-Hospital Care at London's Air Ambulance, The Helipad, 17th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.
7
Bart's Health NHS Trust, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom; London's Air Ambulance, The Helipad, 17th Floor, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.

Abstract

AIM:

To report the initial experience and outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an adjunct to pre-hospital resuscitation of patients with exsanguinating pelvic haemorrhage.

METHODS:

Descriptive case series of consecutive adult patients, treated with pre-hospital Zone III REBOA by a physician-led pre-hospital trauma service, between January 2014 and July 2018.

RESULTS:

REBOA was attempted in 19 trauma patients (13 successful, six failed attempts) and two non-trauma patients (both successful) with exsanguinating pelvic haemorrhage. Trauma patients were severely injured (median ISS 34, IQR: 27-43) and profoundly hypotensive (median systolic blood pressure [SBP] 57, IQR: 40-68 mmHg). REBOA significantly improved blood pressure (Pre-REBOA median SBP 57, IQR: 35-67 mmHg versus Post- REBOA SBP 114, IQR: 86-132 mmHg; Median of differences 66, 95% CI: 25-74 mmHg; P < 0.001). REBOA was associated with significantly lower risk of pre-hospital cardiac arrest (REBOA 0/13 [0%] versus no REBOA 3/6 [50%], P = 0.021) and death from exsanguination (REBOA 0/13 [0%] versus no REBOA 4/6 [67%], P = 0.004), when compared to patients with a failed attempt. Successful REBOA was associated with improved survival (REBOA 8/13 [62%] versus no REBOA 2/6 [33%]; P = 0.350). Distal arterial thrombus requiring thrombectomy was common in the REBOA group (10/13, 77%).

CONCLUSION:

REBOA is a feasible pre-hospital resuscitation strategy for patients with exsanguinating pelvic haemorrhage. REBOA significantly improves blood pressure and may reduce the risk of pre-hospital hypovolaemic cardiac arrest and early death due to exsanguination. Distal arterial thrombus formation is common, and should be actively managed.

KEYWORDS:

Exsanguinating haemorrhage; Exsanguination; Hypovolaemic cardiac arrest; Junctional haemorrhage; Non-compressible torso haemorrhage; Pelvic haemorrhage; REBOA; Resuscitative Endovascular Balloon Occlusion of the Aorta; Trauma haemorrhage; Trauma resuscitation

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