Alistair Eksteen1, Domhnall O'Dochartaigh2,3, Jeff Odenbach4, Matthew J Douma2,5,6, Kristin O'Neill4,2,3,5,6,7,8, Ram Anantha7, Nori L Bradley7,8, Aliyah Gauri4, Sandy Widder5,7. 1. Department of Emergency Medicine, Faculty of Medicine and Dentistry 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada. eksteen@ualberta.ca. 2. Alberta Health Services, Emergency, Edmonton, AB, Canada. 3. Shock Trauma Air Rescue Society (STARS), Edmonton, AB, Canada. 4. Department of Emergency Medicine, Faculty of Medicine and Dentistry 2J2.00 WC Mackenzie Health Sciences Centre, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada. 5. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 6. School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland. 7. Department of Surgery, University of Alberta, Edmonton, AB, USA. 8. Department of Critical Care Medicine, University of British Columbia, Vancouver, Canada.
Abstract
OBJECTIVE: Uncontrolled hemorrhage poses significant morbidity and mortality among injured patients. Resuscitative endovascular balloon occlusion of the aorta (REBOA) utilizes a rapidly-administered minimally invasive transfemoral balloon catheter that is inflated for aortic occlusion, allowing for time to arrange definitive surgical or angiographic intervention. As indications for its use continue to evolve, this study sought to evaluate whether there is a potential need for REBOA implementation in two high-volume trauma centers in Edmonton. METHODS: Patient data within our provincial trauma registry was reviewed between 2015 and 2017 to identify major trauma patients (Injury Severity Score ≥ 12). Patients eligible for REBOA included patients with blunt or penetrating trauma to the torso or pelvis, AND death prior to discharge; and patients taken to the operating room or interventional radiology suite within 4 h of arrival. Charts were reviewed to determine if patients met current conventional criteria for REBOA. RESULTS: Out of 3415 trauma patients during our study period, 237 patients met the registry screen as potentially eligible for REBOA. After primary researcher review, 67 patients underwent full chart review and then 2 trauma surgeons determined that 38 (1.1% of the study population) met criteria for deploying REBOA. CONCLUSION: A small but significant number of trauma patients at the two trauma centers were identified as potential candidates for REBOA use. Implementation of a REBOA program should be done in alignment with existing clinical practice guidelines and professional society recommendations.
OBJECTIVE: Uncontrolled hemorrhage poses significant morbidity and mortality among injured patients. Resuscitative endovascular balloon occlusion of the aorta (REBOA) utilizes a rapidly-administered minimally invasive transfemoral balloon catheter that is inflated for aortic occlusion, allowing for time to arrange definitive surgical or angiographic intervention. As indications for its use continue to evolve, this study sought to evaluate whether there is a potential need for REBOA implementation in two high-volume trauma centers in Edmonton. METHODS:Patient data within our provincial trauma registry was reviewed between 2015 and 2017 to identify major traumapatients (Injury Severity Score ≥ 12). Patients eligible for REBOA included patients with blunt or penetrating trauma to the torso or pelvis, AND death prior to discharge; and patients taken to the operating room or interventional radiology suite within 4 h of arrival. Charts were reviewed to determine if patients met current conventional criteria for REBOA. RESULTS: Out of 3415 traumapatients during our study period, 237 patients met the registry screen as potentially eligible for REBOA. After primary researcher review, 67 patients underwent full chart review and then 2 trauma surgeons determined that 38 (1.1% of the study population) met criteria for deploying REBOA. CONCLUSION: A small but significant number of traumapatients at the two trauma centers were identified as potential candidates for REBOA use. Implementation of a REBOA program should be done in alignment with existing clinical practice guidelines and professional society recommendations.
Entities:
Keywords:
Gap analysis; REBOA; Resuscitative endovascular balloon occlusion
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