Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta: An autopsy study

Bellal Joseph, Kareem Ibraheem, Ansab A. Haider, Narong Kulvatunyou, Andrew Tang, Terence OKeeffe, Zachary M. Bauman, Donald J. Green, Rifat Latifi, Peter Rhee, Tucson Arizona

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings. METHODS: We performed a 4-year retrospective review of all RTs performed at our Level I trauma center. Patients with in-hospital mortality and who underwent subsequent autopsies were included. Patients were divided into blunt and penetrating traumawith and without thoracic injuries. Autopsy reports were reviewed to identify vascular and solid organ injuries. Outcome measure was potential benefit with REBOA. Potential benefit with REBOA was defined based on the ability to safely deploy REBOA. In patients without cardiac, aortic, and major pulmonary vasculature injuries, REBOA was considered potentially beneficial. In all other patients, it was considered as nonbeneficial. RESULTS: A total of 98 patients underwent an RT, of whom 87 had subsequent autopsies and were reviewed. The mean age was 35.25 (SD, 17.85)years, mean admission systolic blood pressure was 51.38 (SD, 70.11)mm Hg, median Injury Severity Score was 29 (interquartile range [IQR], 25-42), and 44 had penetrating injury. Resuscitative endovascular balloon occlusion of the aorta would have been potentially beneficial in 51.2% of patients (22 of 43 patients) with blunt mechanism of trauma, whereas REBOA would have been potentially beneficial in 38.6%of patients (17 of 44 patients) with penetratingmechanism of trauma. A subgroup analysis showed that REBOA use would have been potentially beneficial in 50.0% of blunt thoracic and 33.3% of penetrating thoracic trauma patients. CONCLUSIONS: There are a great enthusiasm and premature efforts to introduce REBOA as an alternative to RT. While there exists a great potential for benefit with REBOA use in the management of noncompressible torso hemorrhage, the current indications for REBOA need to be defined better. Patients with penetrating chest trauma in extremis should be considered an absolute contraindication for REBOA use. The majority of patients with blunt trauma in extremis may potentially benefit from REBOA. However, better criteria will help increase these patients who may potentially benefit from REBOA placement. (J Trauma Acute Care Surg. 2016;81: S128-S132.

Original languageEnglish (US)
Pages (from-to)S128-S132
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number5
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Balloon Occlusion
Aorta
Autopsy
Wounds and Injuries
Thoracotomy
Thorax
Blood Pressure
Torso
Thoracic Injuries
Injury Severity Score
Hemorrhagic Shock
Trauma Centers
Lung Injury
Hospital Mortality

Keywords

  • Autopsy
  • REBOA
  • Resuscitative thoracotomy and noncompressible torso hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta : An autopsy study. / Joseph, Bellal; Ibraheem, Kareem; Haider, Ansab A.; Kulvatunyou, Narong; Tang, Andrew; OKeeffe, Terence; Bauman, Zachary M.; Green, Donald J.; Latifi, Rifat; Rhee, Peter; Arizona, Tucson.

In: Journal of Trauma and Acute Care Surgery, Vol. 81, No. 5, 01.01.2016, p. S128-S132.

Research output: Contribution to journalArticle

Joseph, B, Ibraheem, K, Haider, AA, Kulvatunyou, N, Tang, A, OKeeffe, T, Bauman, ZM, Green, DJ, Latifi, R, Rhee, P & Arizona, T 2016, 'Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta: An autopsy study', Journal of Trauma and Acute Care Surgery, vol. 81, no. 5, pp. S128-S132. https://doi.org/10.1097/TA.0000000000001104
Joseph, Bellal ; Ibraheem, Kareem ; Haider, Ansab A. ; Kulvatunyou, Narong ; Tang, Andrew ; OKeeffe, Terence ; Bauman, Zachary M. ; Green, Donald J. ; Latifi, Rifat ; Rhee, Peter ; Arizona, Tucson. / Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta : An autopsy study. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 81, No. 5. pp. S128-S132.
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T1 - Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta

T2 - An autopsy study

AU - Joseph, Bellal

AU - Ibraheem, Kareem

AU - Haider, Ansab A.

AU - Kulvatunyou, Narong

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Bauman, Zachary M.

AU - Green, Donald J.

AU - Latifi, Rifat

AU - Rhee, Peter

AU - Arizona, Tucson

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N2 - BACKGROUND: Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings. METHODS: We performed a 4-year retrospective review of all RTs performed at our Level I trauma center. Patients with in-hospital mortality and who underwent subsequent autopsies were included. Patients were divided into blunt and penetrating traumawith and without thoracic injuries. Autopsy reports were reviewed to identify vascular and solid organ injuries. Outcome measure was potential benefit with REBOA. Potential benefit with REBOA was defined based on the ability to safely deploy REBOA. In patients without cardiac, aortic, and major pulmonary vasculature injuries, REBOA was considered potentially beneficial. In all other patients, it was considered as nonbeneficial. RESULTS: A total of 98 patients underwent an RT, of whom 87 had subsequent autopsies and were reviewed. The mean age was 35.25 (SD, 17.85)years, mean admission systolic blood pressure was 51.38 (SD, 70.11)mm Hg, median Injury Severity Score was 29 (interquartile range [IQR], 25-42), and 44 had penetrating injury. Resuscitative endovascular balloon occlusion of the aorta would have been potentially beneficial in 51.2% of patients (22 of 43 patients) with blunt mechanism of trauma, whereas REBOA would have been potentially beneficial in 38.6%of patients (17 of 44 patients) with penetratingmechanism of trauma. A subgroup analysis showed that REBOA use would have been potentially beneficial in 50.0% of blunt thoracic and 33.3% of penetrating thoracic trauma patients. CONCLUSIONS: There are a great enthusiasm and premature efforts to introduce REBOA as an alternative to RT. While there exists a great potential for benefit with REBOA use in the management of noncompressible torso hemorrhage, the current indications for REBOA need to be defined better. Patients with penetrating chest trauma in extremis should be considered an absolute contraindication for REBOA use. The majority of patients with blunt trauma in extremis may potentially benefit from REBOA. However, better criteria will help increase these patients who may potentially benefit from REBOA placement. (J Trauma Acute Care Surg. 2016;81: S128-S132.

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