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

Resuscitation. 2019 Feb:135:6-13. doi: 10.1016/j.resuscitation.2018.12.018. Epub 2018 Dec 27.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aorta / surgery
  • Balloon Occlusion* / adverse effects
  • Balloon Occlusion* / methods
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / methods
  • Emergency Medical Services / methods
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / methods
  • Exsanguination* / diagnosis
  • Exsanguination* / therapy
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest* / etiology
  • Out-of-Hospital Cardiac Arrest* / prevention & control
  • Outcome and Process Assessment, Health Care
  • Pelvis*
  • Resuscitation / methods
  • Retrospective Studies
  • Shock, Hemorrhagic* / etiology
  • Shock, Hemorrhagic* / prevention & control
  • Thrombosis / diagnosis
  • Thrombosis / etiology
  • Trauma Severity Indices
  • United Kingdom