Partial Resuscitative Endovascular Balloon Occlusion of the Aorta as a Hemorrhagic Shock Adjunct for Ectopic Pregnancy

Abstract Intractable hemorrhage is a main cause of death in the emergency department (ED). Acute care physicians also encounter various causes of life-threatening hemorrhagic shock, including trauma, ruptured abdominal aortic aneurysms, and postpartum bleeding secondary to placenta previa or placenta abruption. In a recent systematic review, resuscitative endovascular balloon occlusion of the aorta (REBOA) in various clinical settings was found to successfully elevate central blood pressure and control hemodynamic status as an adjunct for surgical hemostasis in life-threatening hemorrhagic shock. However, there are no published reports describing the use of REBOA to control the hemorrhagic status for patients with hemodynamic shock caused by an ectopic pregnancy. Recently, partial REBOA with a halfway balloon inflation increased survival time to 180 min, maintaining the central blood pressure and carotid blood flow. In this study, we treated a patient with hemorrhagic shock caused by a ruptured ectopic pregnancy who underwent an intra-aortic balloon occlusion device deployment in ED and successful surgical hemostasis assisted with partial REBOA. We concluded that alternative and aggressive use of partial REBOA is effective among patients with hemorrhagic shock caused by an obstetrical disease. BACKGROUND Emergency physicians encounter various causes of life-threatening hemorrhagic shock, including trauma, ruptured abdominal aortic aneurysms, and obstetric postpartum bleeding in the emergency department (ED). In such cases, the resuscitative endovascular balloon occlusion of the aorta (REBOA) is effective to control the hemodynamic status as an adjunct for surgical hemostasis Morrison et al. (2016) [1]. CASE PRESENTATION Written informed consent was obtained from the patient. A 38-year-old woman was admitted to our ED with lower abdominal pain. Although her medical history was unremarkable, she had an amenorrhea four weeks previously. The physical examination revealed the following: Glasgow Coma Scale score, E4V4M6; blood pressure (BP), 68/44 mmHg; and heart rate, 141 beats/min. The hemoglobin, hematocrit levels, prothrombin time, and base excess were 10.5 g/dL (normal range, 12.0–16.0 g/dL), 29% (35%–48%), 73% (80%–100%), and -8.2 mmol/L (-2.2 to 1.2 mmol/L), respectively. The human chorionic gonadotropin level was 10225.7 MIU/mL (normal range, < 2.7 MIU/mL). Abdominal ultrasonography and computed tomography (CT) revealed fluid collection in the abdomen an