Alexis D Smith1, Jessica Hudson2, Laura J Moore2, Thomas M Scalea3, Megan L Brenner4. 1. Children's Healthcare of Atlanta, Department of Pediatric Surgery, 5461 Meridian Mark Rd Suite 570, Atlanta, GA 30342. Electronic address: Alexis.smith@choa.org. 2. University of Texas Health Sciences Center at Houston, Department of Surgery, 6550 Fannin Street #583, Houston, TX 77030. 3. R Adams Cowley Shock Trauma Center, Department of Surgery, 22 South Greene Street, Baltimore, MD 21201. 4. University of California Riverside, Department of Surgery, 26520 Cactus Avenue Moreno Valley, CA 92555.
Abstract
BACKGROUND/ PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an alternative technique for traumatic hemorrhage control in the adult population. The purpose of this study is to describe the details of REBOA placement in adolescent trauma patients. METHODS: Patients 18 years of age or less who received REBOA for aortic occlusion (AO) from August 2013 to February 2017 at 2 urban tertiary care centers were included. RESULTS: 7 adolescent trauma patients received REBOA by trauma surgeons for both blunt (n = 4) and penetrating mechanisms (n = 3); mean age was 17 + 1.5 years, mean admission lactate 13.0 + 4.85 mmol/L, and mean Hgb 10.7 + 2.7 g/dL. 3 patients received REBOA through a 12Fr sheath and 4 through a 7Fr sheath. AO occurred mostly at the distal thoracic aorta (Zone I) (85.7%) and also in the distal abdominal aorta (Zone III) (14.3%). 57% of patients were in arrest with ongoing CPR at the time of REBOA. In-hospital mortality was 57%; all of these patients were in arrest at the time of REBOA, had return of spontaneous circulation (ROSC), and survived to the operating room. No complications from REBOA were identified. CONCLUSION: REBOA appears to be feasible for use in adolescents despite their smaller caliber vessels, even with use of a 12Fr sheath. REBOA results in improved physiology and can bridge adolescent trauma patients presenting in extremis to the operating room. TYPE OF STUDY: Treatment/therapeutic study LEVEL OF EVIDENCE: Level IV.
BACKGROUND/ PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an alternative technique for traumatic hemorrhage control in the adult population. The purpose of this study is to describe the details of REBOA placement in adolescent traumapatients. METHODS:Patients 18 years of age or less who received REBOA for aortic occlusion (AO) from August 2013 to February 2017 at 2 urban tertiary care centers were included. RESULTS: 7 adolescent traumapatients received REBOA by trauma surgeons for both blunt (n = 4) and penetrating mechanisms (n = 3); mean age was 17 + 1.5 years, mean admission lactate 13.0 + 4.85 mmol/L, and mean Hgb 10.7 + 2.7 g/dL. 3 patients received REBOA through a 12Fr sheath and 4 through a 7Fr sheath. AO occurred mostly at the distal thoracic aorta (Zone I) (85.7%) and also in the distal abdominal aorta (Zone III) (14.3%). 57% of patients were in arrest with ongoing CPR at the time of REBOA. In-hospital mortality was 57%; all of these patients were in arrest at the time of REBOA, had return of spontaneous circulation (ROSC), and survived to the operating room. No complications from REBOA were identified. CONCLUSION: REBOA appears to be feasible for use in adolescents despite their smaller caliber vessels, even with use of a 12Fr sheath. REBOA results in improved physiology and can bridge adolescent traumapatients presenting in extremis to the operating room. TYPE OF STUDY: Treatment/therapeutic study LEVEL OF EVIDENCE: Level IV.
Authors: Christina M Theodorou; A Francois Trappey; Carl A Beyer; Kaeli J Yamashiro; Shinjiro Hirose; Joseph M Galante; Alana L Beres; Jacob T Stephenson Journal: J Pediatr Surg Date: 2020-09-22 Impact factor: 2.549
Authors: Adam Power; Asha Parekh; Oonagh Scallan; Shane Smith; Teresa Novick; Neil Parry; Laura Moore Journal: Trauma Surg Acute Care Open Date: 2021-01-08