David Marc Northern1, Justin D Manley, Regan Lyon, Daniel Farber, Benjamin J Mitchell, Kristopher J Filak, Jonathan Lundy, Joe J DuBose, Todd E Rasmussen, John B Holcomb. 1. From the Department of Surgery (J.D.M.), University of Alabama-Birmingham Medical Center, Birmingham, Alabama; 720th Special Operations Surgical Team, 720th Operations Support Squadron, 720th Special Tactics Group, 24th Special Operations Wing, Air Force Special Operations Command (AFSOC), (D.M.N., R.L., D.F., K.J.F.), Hurlburt Field, Pensacola, Florida; Department of Emergency Medicine (B.J.M.), University of Alabama-Birmingham Medical Center, Birmingham, Alabama; Department of General Surgery (J.L.), Carl R. Darnall Army Medical Center, Fort Hood, Texas; Baltimore CSTARS, R Adams Cowley Shock Trauma (J.J.D.), University of Maryland, Baltimore; US Department of Defense Combat Casualty Care Research Program, Fort Detrick, Department of Surgery (T.E.R.), The Uniformed Services University of the Health Sciences, Bethesda, Maryland; and Department of Surgery (J.B.H.), Center for Translational Injury Research, UT Health, Houston, Texas.
Abstract
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of noncompressible torso hemorrhage is a technology that is increasingly being utilized in the combat casualty setting. Its use in the resource restricted environment holds potential to improve hemorrhage control, decrease blood product utilization, decrease morbidity, and improve combat mortality. The objective of this report is to present the single largest series of REBOA use on severely injured combat casualties. METHODS: Over an 18-month period, austere surgical teams comprised of coalition partners provided initial damage control resuscitation (DCR) and surgical stabilization for over 2,300 combat casualties prior to transferring patients to the next level of trauma care. RESULTS: Twenty patients presented with injuries from explosion and gunshot wounds with mean initial heart rate of 129 bpm and mean initial systolic blood pressure of 71 mm Hg. Femoral cutdowns were used in six patients. Aortic occlusion was achieved with REBOA catheter placement in Zone 1 (n = 17) and Zone 3 (n = 2). Systolic blood pressure increased an average of 56 mm Hg with aortic occlusion. There were no access related site complications. All patients survived transport to the next level of care. The majority of blood products transfused in this cohort were whole blood, largely supported by emergent blood drives. CONCLUSION: This series demonstrates the potential for REBOA as a lifesaving technique for the patient who presents with hemodynamic instability and noncompressible torso hemorrhage. Resuscitative endovascular balloon occlusion of the aorta allows austere surgical teams to rapidly stabilize severely injured combat casualties, expand capability, and provide enhanced DCR while minimizing personnel, resources, and blood product utilization. The use of "whole blood only" strategy for DCR shows potential to be superior to traditional component therapy, and when combined with "proactive" REBOA utilization, provides significant improvements in hemodynamics and hemorrhage control. LEVEL OF EVIDENCE: Case series, level V.
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) for control of noncompressible torso hemorrhage is a technology that is increasingly being utilized in the combat casualty setting. Its use in the resource restricted environment holds potential to improve hemorrhage control, decrease blood product utilization, decrease morbidity, and improve combat mortality. The objective of this report is to present the single largest series of REBOA use on severely injured combat casualties. METHODS: Over an 18-month period, austere surgical teams comprised of coalition partners provided initial damage control resuscitation (DCR) and surgical stabilization for over 2,300 combat casualties prior to transferring patients to the next level of trauma care. RESULTS: Twenty patients presented with injuries from explosion and gunshot wounds with mean initial heart rate of 129 bpm and mean initial systolic blood pressure of 71 mm Hg. Femoral cutdowns were used in six patients. Aortic occlusion was achieved with REBOA catheter placement in Zone 1 (n = 17) and Zone 3 (n = 2). Systolic blood pressure increased an average of 56 mm Hg with aortic occlusion. There were no access related site complications. All patients survived transport to the next level of care. The majority of blood products transfused in this cohort were whole blood, largely supported by emergent blood drives. CONCLUSION: This series demonstrates the potential for REBOA as a lifesaving technique for the patient who presents with hemodynamic instability and noncompressible torso hemorrhage. Resuscitative endovascular balloon occlusion of the aorta allows austere surgical teams to rapidly stabilize severely injured combat casualties, expand capability, and provide enhanced DCR while minimizing personnel, resources, and blood product utilization. The use of "whole blood only" strategy for DCR shows potential to be superior to traditional component therapy, and when combined with "proactive" REBOA utilization, provides significant improvements in hemodynamics and hemorrhage control. LEVEL OF EVIDENCE: Case series, level V.
Authors: Alexis L Cralley; Ernest E Moore; Daniel Kissau; Julia R Coleman; Navin Vigneshwar; Margot DeBot; Terry R Schaid; Hunter B Moore; Mitchell J Cohen; Kirk Hansen; Christopher C Silliman; Angela Sauaia; Charles J Fox Journal: J Trauma Acute Care Surg Date: 2022-05-12 Impact factor: 3.697
Authors: Sarah C Stokes; Christina M Theodorou; Scott A Zakaluzny; Joseph J DuBose; Rachel M Russo Journal: J Trauma Acute Care Surg Date: 2021-08-01 Impact factor: 3.697
Authors: J C de Schoutheete; I Fourneau; F Waroquier; L De Cupere; M O'Connor; K Van Cleynenbreugel; J C Ceccaldi; S Nijs Journal: World J Emerg Surg Date: 2018-11-21 Impact factor: 5.469
Authors: Marianne A Thrailkill; Kevin H Gladin; Catherine R Thorpe; Teryn R Roberts; Jae H Choi; Kevin K Chung; Corina N Necsoiu; Todd E Rasmussen; Leopoldo C Cancio; Andriy I Batchinsky Journal: Scand J Trauma Resusc Emerg Med Date: 2021-01-06 Impact factor: 2.953
Authors: Yaset Caicedo; Linda M Gallego; Hugo Jc Clavijo; Natalia Padilla-Londoño; Cindy-Natalia Gallego; Isabella Caicedo-Holguín; Mónica Guzmán-Rodríguez; Juan J Meléndez-Lugo; Alberto F García; Alexander E Salcedo; Michael W Parra; Fernando Rodríguez-Holguín; Carlos A Ordoñez Journal: Eur J Med Res Date: 2022-10-17 Impact factor: 4.981
Authors: Suzanne M Vrancken; Boudewijn L S Borger van der Burg; Joseph J DuBose; Jacob J Glaser; Tal M Hörer; Rigo Hoencamp Journal: J Trauma Acute Care Surg Date: 2022-01-21 Impact factor: 3.697