Robbie Lendrum1, Zane Perkins2, Manik Chana3, Max Marsden4, Ross Davenport5, Gareth Grier6, Samy Sadek7, Gareth Davies2. 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. Crown
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 traumapatients (13 successful, six failed attempts) and two non-traumapatients (both successful) with exsanguinating pelvic haemorrhage. Traumapatients 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. Crown
Authors: E Ter Avest; L Carenzo; R A Lendrum; M D Christian; R M Lyon; C Coniglio; M Rehn; D J Lockey; Z B Perkins Journal: Crit Care Date: 2022-06-20 Impact factor: 19.334
Authors: Juan José Meléndez-Lugo; Yaset Caicedo; Mónica Guzmán-Rodríguez; José Julián Serna; Juliana Ordoñez; Edison Angamarca; Alberto García; Luis Fernando Pino; Laureano Quintero; Michael W Parra; Carlos A Ordoñez Journal: Colomb Med (Cali) Date: 2020-12-30
Authors: Jevgenia Zilberman-Rudenko; Brandon Behrens; Belinda McCully; Elizabeth N Dewey; Sawyer G Smith; James M Murphy; Andrew Goodman; Samantha J Underwood; Elizabeth A Rick; Brianne M Madtson; Michelle E Thompson; Jacob J Glaser; John B Holcomb; Martin A Schreiber Journal: J Trauma Acute Care Surg Date: 2020-09 Impact factor: 3.697