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Injury. 2019 Apr 24. pii: S0020-1383(19)30255-4. doi: 10.1016/j.injury.2019.04.024. [Epub ahead of print]

Consensus on resuscitative endovascular balloon occlusion of the Aorta: A first consensus paper using a Delphi method.

Author information

1
Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands. Electronic address: blsborgervanderburg@alrijne.nl.
2
Department of Trauma, Hillel Yaffe Medical Center, Hadera, Israel.
3
R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA.
4
Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital, Örebro, Sweden.
5
Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands.

Abstract

BACKGROUND:

To further strengthen the evidence base on the use of Resuscitative Endovascular Balloon occlusion of the Aorta (REBOA) we performed a Delphi consensus. The aim of this paper is to establish consensus on the indications and contraindications for the use of REBOA in trauma and non-trauma patients based on the existing evidence and expertise.

STUDY DESIGN:

A literature review facilitated the design of a three-round Delphi questionnaire. Delphi panelists were identified by the investigators. Consensus was reached when at least 70% of the panelists responded to the survey and more than 70% of respondents reached agreement or disagreement.

RESULTS:

Panel members reached consensus on potential indications, contra-indications and settings for use of REBOA (excluding the pre hospital environment), physiological parameters for patient selection and indications for early femoral access. Panel members failed to reach consensus on the use of REBOA in patients in extremis (no pulse, no blood pressure) and the use of REBOA in patients with two major bleeding sites.

CONCLUSIONS:

Consensus was reached on indications, contra indications, physiological parameters for patient selection for REBOA and early femoral access. The panel did not reach consensus on the use of REBOA in patients in pre-hospital settings, patients in extremis (no pulse, no blood pressure) and in patients with 2 or more major bleeding sites. Further research should focus on the indications of REBOA in pre hospital settings, patients in near cardiac arrest and REBOA inflation times.

KEYWORDS:

Delphi consensus; Indications; REBOA; contra indications

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