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REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)

Brauchen wir das wirklich?

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)

Do we really need it?

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Zusammenfassung

Hintergrund

Nichtkomprimierbare Blutungen des Körperstamms stellen eine der Haupttodesursachen traumatisierter Patienten, sowohl im militärischen als auch im zivilen Bereich, dar.

Ziel

Die REBOA-Technik (REBOA Resuscitative Endovascular Balloon Occlusion of the Aorta), mögliche Einsatzgebiete, potenzielle Komplikationen und die Frage nach der Relevanz im Alltag des Notfallmediziners sollen erläutert werden.

Material und Methode

Beschreibung bisheriger Einsatzgebiete von REBOA, Auswertung der aktuellen Studienlage, Diskussion der praktischen Anwendung.

Ergebnisse

Im Rahmen der „Damage Control“ wird ein über die Leistenarterien eingebrachter Ballon proximal der vermuteten Blutungsquelle in der Aorta platziert, um damit ein Verbluten des Patienten zu verhindern und eine weitere Versorgung durchführen zu können. Die aktuelle Studienlage zeigt, dass REBOA in den meisten Fällen zu einer Verbesserung des systolischen Blutdrucks sowie des mittleren arteriellen Blutdrucks und zu einer Reduktion der Herzfrequenz führt. Eine Reduktion der blutungsassoziierten Mortalität konnte bislang jedoch noch nicht sicher gezeigt werden.

Schlussfolgerungen

Aufgrund der möglichen Komplikationen während und nach der REBOA-Prozedur ist eine gefäßchirurgische Expertise unabdingbar. Zudem sind wegen der geringen Fallzahlen sowohl anfängliche Schulungen als auch regelmäßige Übungen notwendig. Dennoch stellt REBOA eine potenziell lebensrettende Sofortmaßnahme dar, die als solche im Portfolio von Traumazentren vorgehalten werden sollte.

Abstract

Background

Non-compressible torso hemorrhage (NCTH) continues to be one of the major causes of death, both in military and civilian trauma patients.

Objective

Explanation of the REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) technique, potential fields of application, potential complications, relevance in daily emergency medicine.

Material and method

Description of previous areas of REBOA application, evaluation of current trauma surgical literature, discussion regarding the practical utilization.

Results

During the REBOA procedure, a transfemoral balloon catheter is placed into the aorta to establish inflow control and maintain blood pressure until permanent hemostasis is achieved. The current trauma surgical literature shows that REBOA is successfully able to improve both the systolic blood pressure and the mean arterial pressure, and reduce the heart rate in most of the cases. However, there is still no valid evidence for a reduction in hemorrhage-associated mortality.

Conclusions

Due to potential vascular complications of REBOA, endovascular expertise is indispensable; in addition, given the small numbers of cases, both the initial and continued training are important. Nevertheless, REBOA represents a potentially life-saving tool that should be part of the armamentarium of any large trauma center.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    M. Wortmann & D. Böckler

  2. Klinik für Gefäß- und Thoraxchirurgie, Ammerlandklinik/Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland

    K. Elias

  3. Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Klinikum Augsburg, Stenglinstr 2, 86156, Augsburg, Deutschland

    S. Zerwes &  A. Hyhlik-Dürr

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  1. M. Wortmann
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  2. K. Elias
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  3. S. Zerwes
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  5. A. Hyhlik-Dürr
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Correspondence to A. Hyhlik-Dürr.

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M. Wortmann, K. Elias, S. Zerwes, D. Böckler und A. Hyhlik-Dürr geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Wortmann, M., Elias, K., Zerwes, S. et al. REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta). Notfall Rettungsmed 22, 100–110 (2019). https://doi.org/10.1007/s10049-017-0396-1

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