Christina M Theodorou1, Edgardo S Salcedo1, Joseph J DuBose2, Joseph M Galante1. 1. Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA. 2. Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Abstract
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is emerging as a viable intervention for hemorrhagic shock. Training surgeons to place the device is only part of the process. We hypothesize that implementation challenges extend beyond surgical skills training and initial REBOA use should not be expected to mirror published success. METHODS: All REBOA placements from January 2016 to February 2017 at a level 1 trauma center were reviewed for opportunities for improvement. From September 2016 to February 2017, all patients meeting highest trauma activation criteria were reviewed against our REBOA algorithm to identify patients meeting criteria for REBOA placement but not undergoing the procedure. RESULTS: REBOA was introduced at our institution in September 2015, with the first placement in January 2016. Trauma surgery, emergency department, and operating room staff underwent training. Nine patients had REBOA placed with six survivors. One patient underwent an unsuccessful REBOA attempt and died. Four patients had complications from REBOA. Eight additional patients met indications but did not undergo REBOA. CONCLUSIONS: Successful REBOA use requires more than teaching surgeons indications and techniques. For a successful REBOA program, system factors must be addressed. System processes must ensure equipment and procedures are standardized and familiar to all involved. Complications should be expected.
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is emerging as a viable intervention for hemorrhagic shock. Training surgeons to place the device is only part of the process. We hypothesize that implementation challenges extend beyond surgical skills training and initial REBOA use should not be expected to mirror published success. METHODS: All REBOA placements from January 2016 to February 2017 at a level 1 trauma center were reviewed for opportunities for improvement. From September 2016 to February 2017, all patients meeting highest trauma activation criteria were reviewed against our REBOA algorithm to identify patients meeting criteria for REBOA placement but not undergoing the procedure. RESULTS: REBOA was introduced at our institution in September 2015, with the first placement in January 2016. Trauma surgery, emergency department, and operating room staff underwent training. Nine patients had REBOA placed with six survivors. One patient underwent an unsuccessful REBOA attempt and died. Four patients had complications from REBOA. Eight additional patients met indications but did not undergo REBOA. CONCLUSIONS: Successful REBOA use requires more than teaching surgeons indications and techniques. For a successful REBOA program, system factors must be addressed. System processes must ensure equipment and procedures are standardized and familiar to all involved. Complications should be expected.
Authors: M Austin Johnson; Timothy K Williams; Sarah-Ashley E Ferencz; Anders J Davidson; Rachel M Russo; William T O'Brien; Joseph M Galante; J Kevin Grayson; Lucas P Neff Journal: J Trauma Acute Care Surg Date: 2017-07 Impact factor: 3.313
Authors: Anders J Davidson; Rachel M Russo; Viktor A Reva; Megan L Brenner; Laura J Moore; Chad Ball; Eileen Bulger; Charles J Fox; Joseph J DuBose; Ernest E Moore; Todd E Rasmussen Journal: J Trauma Acute Care Surg Date: 2018-01 Impact factor: 3.313
Authors: Scott A Zakaluzny; Brian C Beldowicz; Edgardo S Salcedo; Joseph J DuBose; Laura J Moore; Megan Brenner Journal: J Trauma Acute Care Surg Date: 2019-02 Impact factor: 3.313
Authors: Carole Y Villamaria; Jonathan L Eliason; Lena M Napolitano; R Brent Stansfield; Jerry R Spencer; Todd E Rasmussen Journal: J Trauma Acute Care Surg Date: 2014-04 Impact factor: 3.313
Authors: Michael A Vella; Ryan Peter Dumas; Joseph DuBose; Jonathan Morrison; Thomas Scalea; Laura Moore; Jeanette Podbielski; Kenji Inaba; Alice Piccinini; David S Kauvar; Valorie L Baggenstoss; Chance Spalding; Charles Fox; Ernest E Moore; Jeremy W Cannon Journal: Trauma Surg Acute Care Open Date: 2019-11-11
Authors: Christina M Theodorou; Tanya N Rinderknecht; Eugenia Girda; Joseph M Galante; Rachel M Russo Journal: J Trauma Acute Care Surg Date: 2022-01-01 Impact factor: 3.313
Authors: Nori L Bradley; W Robert Leeper; Derek Roberts; Chad G Ball; Andrew Beckett; Paul Engels; Emilie Joos; Kosar Khwaja; Andrew Kirkpatrick; Jacinthe Lampron; Sam Minor; Neil Parry; Joao Neto Rezende; Sandy Widder; Najma Ahmed; Lawrence Gillman; David Gomez; Morad Hameed; Michael Kim; Patrick Murphy; Rahima Nenshi; Timothy Rice; Kelly Vogt Journal: Can J Surg Date: 2022-05-11 Impact factor: 2.840
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