A feasibility study of partial REBOA data in a high-volume trauma center
Purpose Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporize patients with infradiaphragmatic hemorrhage. Current guidelines advise 30 min, vs ≤ 30 min) Results 46 patients were included, with 14 treated with P-REBOA. There were no demographic differences between P...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2022-02, Vol.48 (1), p.299-305 |
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| creator | Madurska, Marta J. McLenithan, Ashley Scalea, Thomas M. Kundi, Rishi White, Joseph M. Morrison, Jonathan J. DuBose, Joseph J. |
| description | Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporize patients with infradiaphragmatic hemorrhage. Current guidelines advise 30 min, vs ≤ 30 min)
Results
46 patients were included, with 14 treated with P-REBOA. There were no demographic differences between P-REBOA and C-REBOA. Prolonged (> 30 min) REBOA (regardless of type of occlusion) was associated with increased mortality (32% vs 0%,
p
= 0.044) and organ failure. When comparing prolonged P-REBOA with C-REBOA, there was a trend toward lower ventilator days [19 (11) vs 6 (9);
p
= 0.483] and dialysis (36.4% vs 16.7%;
p
= 0.228) with significantly less vasopressor requirement (72.7% vs 33.3%;
p
= 0.026).
Conclusion
P-REBOA can be delivered in a clinical setting, but is not currently associated with improved survival in prolonged occlusion. In survivors, there is a trend toward lower organ support needs, suggesting that the technique might help to mitigate ischemic organ injury. More clinical data are needed to clarify the benefit of partial occlusion REBOA. |
| doi_str_mv | 10.1007/s00068-020-01561-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2475396685</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2475396685</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-4f39d81797cc4d1403f01103855f645e6a2b8801af3449c9d9df608ada62014f3</originalsourceid><addsrcrecordid>eNp9kE1LAzEURYMotlb_gAsJuHEz-jL5mGRZS7VCoSC6DulM0k6Zj5rMCP33Tp1awYWrPMi59z0OQtcE7glA8hAAQMgIYoiAcEEidoKGRAoaKcXI6XGmdIAuQth0NAgen6MBpVQpmcghmo2xsybky7zImx0OTZvtcO3w1vgmNwV-nT4uxjgzjcF5hQ1e56t19FkXbWlx401bGpzaqrH-Ep05UwR7dXhH6P1p-jaZRfPF88tkPI9SmvAmYo6qTJJEJWnKMsKAOiAEqOTcCcatMPFSSiDGUcZUqjKVOQHSZEbEQLr0CN31vVtff7Q2NLrMQ2qLwlS2boOOWcKpEkLyDr39g27q1lfddToWsWCCE9hTcU-lvg7BW6e3Pi-N32kCeu9Z955151l_e9asC90cqttlabNj5EdsB9AeCN1XtbL-d_c_tV-dAoVh</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2626465105</pqid></control><display><type>article</type><title>A feasibility study of partial REBOA data in a high-volume trauma center</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Madurska, Marta J. ; McLenithan, Ashley ; Scalea, Thomas M. ; Kundi, Rishi ; White, Joseph M. ; Morrison, Jonathan J. ; DuBose, Joseph J.</creator><creatorcontrib>Madurska, Marta J. ; McLenithan, Ashley ; Scalea, Thomas M. ; Kundi, Rishi ; White, Joseph M. ; Morrison, Jonathan J. ; DuBose, Joseph J.</creatorcontrib><description>Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporize patients with infradiaphragmatic hemorrhage. Current guidelines advise < 30 min, to avoid ischemia/ reperfusion injury, whenever possible. The technique of partial REBOA (P-REBOA) has been developed to minimize the effects of distal ischemia. This study presents our clinical experience with P-REBOA, comparing outcomes to complete occlusion (C-REBOA).
Patients and methods
Retrospective analysis of patients’ electronic data and local REBOA registry between January 2016 and May 2019. Inclusion criteria: adult trauma patients who received Zone I C-REBOA or P-REBOA for infradiaphragmatic hemorrhage, who underwent attempted exploration in the operating room. Comparison of outcomes based on REBOA technique (P-REBOA vs C-REBOA) and occlusion time (> 30 min, vs ≤ 30 min)
Results
46 patients were included, with 14 treated with P-REBOA. There were no demographic differences between P-REBOA and C-REBOA. Prolonged (> 30 min) REBOA (regardless of type of occlusion) was associated with increased mortality (32% vs 0%,
p
= 0.044) and organ failure. When comparing prolonged P-REBOA with C-REBOA, there was a trend toward lower ventilator days [19 (11) vs 6 (9);
p
= 0.483] and dialysis (36.4% vs 16.7%;
p
= 0.228) with significantly less vasopressor requirement (72.7% vs 33.3%;
p
= 0.026).
Conclusion
P-REBOA can be delivered in a clinical setting, but is not currently associated with improved survival in prolonged occlusion. In survivors, there is a trend toward lower organ support needs, suggesting that the technique might help to mitigate ischemic organ injury. More clinical data are needed to clarify the benefit of partial occlusion REBOA.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-020-01561-4</identifier><identifier>PMID: 33399878</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aorta ; Balloon Occlusion ; Coronary vessels ; Critical Care Medicine ; Emergency medical care ; Emergency Medicine ; Endovascular Procedures ; Feasibility Studies ; Humans ; Intensive ; Ischemia ; Medicine ; Medicine & Public Health ; Original Article ; Resuscitation ; Retrospective Studies ; Shock, Hemorrhagic - therapy ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Trauma ; Trauma Centers ; Traumatic Surgery</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2022-02, Vol.48 (1), p.299-305</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>2021. Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-4f39d81797cc4d1403f01103855f645e6a2b8801af3449c9d9df608ada62014f3</citedby><cites>FETCH-LOGICAL-c375t-4f39d81797cc4d1403f01103855f645e6a2b8801af3449c9d9df608ada62014f3</cites><orcidid>0000-0001-7462-8456 ; 0000-0001-5613-871X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-020-01561-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-020-01561-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33399878$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Madurska, Marta J.</creatorcontrib><creatorcontrib>McLenithan, Ashley</creatorcontrib><creatorcontrib>Scalea, Thomas M.</creatorcontrib><creatorcontrib>Kundi, Rishi</creatorcontrib><creatorcontrib>White, Joseph M.</creatorcontrib><creatorcontrib>Morrison, Jonathan J.</creatorcontrib><creatorcontrib>DuBose, Joseph J.</creatorcontrib><title>A feasibility study of partial REBOA data in a high-volume trauma center</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporize patients with infradiaphragmatic hemorrhage. Current guidelines advise < 30 min, to avoid ischemia/ reperfusion injury, whenever possible. The technique of partial REBOA (P-REBOA) has been developed to minimize the effects of distal ischemia. This study presents our clinical experience with P-REBOA, comparing outcomes to complete occlusion (C-REBOA).
Patients and methods
Retrospective analysis of patients’ electronic data and local REBOA registry between January 2016 and May 2019. Inclusion criteria: adult trauma patients who received Zone I C-REBOA or P-REBOA for infradiaphragmatic hemorrhage, who underwent attempted exploration in the operating room. Comparison of outcomes based on REBOA technique (P-REBOA vs C-REBOA) and occlusion time (> 30 min, vs ≤ 30 min)
Results
46 patients were included, with 14 treated with P-REBOA. There were no demographic differences between P-REBOA and C-REBOA. Prolonged (> 30 min) REBOA (regardless of type of occlusion) was associated with increased mortality (32% vs 0%,
p
= 0.044) and organ failure. When comparing prolonged P-REBOA with C-REBOA, there was a trend toward lower ventilator days [19 (11) vs 6 (9);
p
= 0.483] and dialysis (36.4% vs 16.7%;
p
= 0.228) with significantly less vasopressor requirement (72.7% vs 33.3%;
p
= 0.026).
Conclusion
P-REBOA can be delivered in a clinical setting, but is not currently associated with improved survival in prolonged occlusion. In survivors, there is a trend toward lower organ support needs, suggesting that the technique might help to mitigate ischemic organ injury. More clinical data are needed to clarify the benefit of partial occlusion REBOA.</description><subject>Adult</subject><subject>Aorta</subject><subject>Balloon Occlusion</subject><subject>Coronary vessels</subject><subject>Critical Care Medicine</subject><subject>Emergency medical care</subject><subject>Emergency Medicine</subject><subject>Endovascular Procedures</subject><subject>Feasibility Studies</subject><subject>Humans</subject><subject>Intensive</subject><subject>Ischemia</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Resuscitation</subject><subject>Retrospective Studies</subject><subject>Shock, Hemorrhagic - therapy</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Trauma</subject><subject>Trauma Centers</subject><subject>Traumatic Surgery</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kE1LAzEURYMotlb_gAsJuHEz-jL5mGRZS7VCoSC6DulM0k6Zj5rMCP33Tp1awYWrPMi59z0OQtcE7glA8hAAQMgIYoiAcEEidoKGRAoaKcXI6XGmdIAuQth0NAgen6MBpVQpmcghmo2xsybky7zImx0OTZvtcO3w1vgmNwV-nT4uxjgzjcF5hQ1e56t19FkXbWlx401bGpzaqrH-Ep05UwR7dXhH6P1p-jaZRfPF88tkPI9SmvAmYo6qTJJEJWnKMsKAOiAEqOTcCcatMPFSSiDGUcZUqjKVOQHSZEbEQLr0CN31vVtff7Q2NLrMQ2qLwlS2boOOWcKpEkLyDr39g27q1lfddToWsWCCE9hTcU-lvg7BW6e3Pi-N32kCeu9Z955151l_e9asC90cqttlabNj5EdsB9AeCN1XtbL-d_c_tV-dAoVh</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Madurska, Marta J.</creator><creator>McLenithan, Ashley</creator><creator>Scalea, Thomas M.</creator><creator>Kundi, Rishi</creator><creator>White, Joseph M.</creator><creator>Morrison, Jonathan J.</creator><creator>DuBose, Joseph J.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7462-8456</orcidid><orcidid>https://orcid.org/0000-0001-5613-871X</orcidid></search><sort><creationdate>20220201</creationdate><title>A feasibility study of partial REBOA data in a high-volume trauma center</title><author>Madurska, Marta J. ; McLenithan, Ashley ; Scalea, Thomas M. ; Kundi, Rishi ; White, Joseph M. ; Morrison, Jonathan J. ; DuBose, Joseph J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-4f39d81797cc4d1403f01103855f645e6a2b8801af3449c9d9df608ada62014f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Aorta</topic><topic>Balloon Occlusion</topic><topic>Coronary vessels</topic><topic>Critical Care Medicine</topic><topic>Emergency medical care</topic><topic>Emergency Medicine</topic><topic>Endovascular Procedures</topic><topic>Feasibility Studies</topic><topic>Humans</topic><topic>Intensive</topic><topic>Ischemia</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Resuscitation</topic><topic>Retrospective Studies</topic><topic>Shock, Hemorrhagic - therapy</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Trauma</topic><topic>Trauma Centers</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Madurska, Marta J.</creatorcontrib><creatorcontrib>McLenithan, Ashley</creatorcontrib><creatorcontrib>Scalea, Thomas M.</creatorcontrib><creatorcontrib>Kundi, Rishi</creatorcontrib><creatorcontrib>White, Joseph M.</creatorcontrib><creatorcontrib>Morrison, Jonathan J.</creatorcontrib><creatorcontrib>DuBose, Joseph J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Madurska, Marta J.</au><au>McLenithan, Ashley</au><au>Scalea, Thomas M.</au><au>Kundi, Rishi</au><au>White, Joseph M.</au><au>Morrison, Jonathan J.</au><au>DuBose, Joseph J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A feasibility study of partial REBOA data in a high-volume trauma center</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2022-02-01</date><risdate>2022</risdate><volume>48</volume><issue>1</issue><spage>299</spage><epage>305</epage><pages>299-305</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract>Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporize patients with infradiaphragmatic hemorrhage. Current guidelines advise < 30 min, to avoid ischemia/ reperfusion injury, whenever possible. The technique of partial REBOA (P-REBOA) has been developed to minimize the effects of distal ischemia. This study presents our clinical experience with P-REBOA, comparing outcomes to complete occlusion (C-REBOA).
Patients and methods
Retrospective analysis of patients’ electronic data and local REBOA registry between January 2016 and May 2019. Inclusion criteria: adult trauma patients who received Zone I C-REBOA or P-REBOA for infradiaphragmatic hemorrhage, who underwent attempted exploration in the operating room. Comparison of outcomes based on REBOA technique (P-REBOA vs C-REBOA) and occlusion time (> 30 min, vs ≤ 30 min)
Results
46 patients were included, with 14 treated with P-REBOA. There were no demographic differences between P-REBOA and C-REBOA. Prolonged (> 30 min) REBOA (regardless of type of occlusion) was associated with increased mortality (32% vs 0%,
p
= 0.044) and organ failure. When comparing prolonged P-REBOA with C-REBOA, there was a trend toward lower ventilator days [19 (11) vs 6 (9);
p
= 0.483] and dialysis (36.4% vs 16.7%;
p
= 0.228) with significantly less vasopressor requirement (72.7% vs 33.3%;
p
= 0.026).
Conclusion
P-REBOA can be delivered in a clinical setting, but is not currently associated with improved survival in prolonged occlusion. In survivors, there is a trend toward lower organ support needs, suggesting that the technique might help to mitigate ischemic organ injury. More clinical data are needed to clarify the benefit of partial occlusion REBOA.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33399878</pmid><doi>10.1007/s00068-020-01561-4</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7462-8456</orcidid><orcidid>https://orcid.org/0000-0001-5613-871X</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | European journal of trauma and emergency surgery (Munich : 2007), 2022-02, Vol.48 (1), p.299-305 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aorta Balloon Occlusion Coronary vessels Critical Care Medicine Emergency medical care Emergency Medicine Endovascular Procedures Feasibility Studies Humans Intensive Ischemia Medicine Medicine & Public Health Original Article Resuscitation Retrospective Studies Shock, Hemorrhagic - therapy Sports Medicine Surgery Surgical Orthopedics Trauma Trauma Centers Traumatic Surgery |
| title | A feasibility study of partial REBOA data in a high-volume trauma center |
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