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Der Unfallchirurg

, Volume 121, Issue 7, pp 537–543 | Cite as

„Resuscitative endovascular balloon occlusion of the aorta“

Überbrückende Maßnahme bis zur operativen Versorgung
  • K. Elias
  • M. Engelhardt
Leitthema

Zusammenfassung

Hintergrund

Unbeherrschbare Blutungen sind nach wie vor die häufigste Todesursache bei Unfallopfern. Die „resuscitative balloon occlusion of the aorta“ (REBOA) stellt eine endovaskuläre Alternative zur etablierten Notfallthorakotomie mit aortalem „cross-clamping“ bei Patienten mit schwerer abdomineller oder pelviner Blutung dar.

Ziel der Arbeit

Der Beitrag vermittelt erste Erfahrungen mit REBOA.

Methode

Anhand der aktuellen Literatur und eigener Erfahrungen werden die pathophysiologischen Hintergründe, Indikationen, Kontraindikationen, technische Details und erste Ergebnisse mit REBOA dargestellt.

Ergebnisse

Das Verfahren ist indiziert bei Patienten im therapierefraktären hämorrhagischen Schock mit abdomineller oder pelviner Blutung. Über einen transfemoralen Zugang wird ein Okklusionsballon in der Aorta platziert und gefüllt. Je nach Indikation erfolgt die aortale Okklusion supradiaphragmal (Zone I) oder infrarenal (Zone III). Experimentelle Ergebnisse belegen einen signifikanten Anstieg des zentralen Perfusionsdrucks durch das Manöver. Erste klinische Daten deuten darüber hinaus eine Verbesserung der Überlebensrate von Traumapatienten an. Mit Weiterentwicklung der Katheter und Minimierung des Zugangstraumas durch Einführung von kleinlumigen 7‑F-Schleusen konnte die perioperative Komplikationsrate gesenkt werden.

Schlussfolgerung

„Resuscitative endovascular balloon occlusion of the aorta“ ist ein vielversprechendes endovaskuläres Verfahren zur temporären Kreislaufstabilisierung von Patienten im hämorrhagischen Schock. Die klinische Überlegenheit der Technik gegenüber der klassischen Notfallthorakotomie muss jedoch erst in größeren Registerstudien belegt werden.

Schlüsselwörter

Blutung Schock Trauma Endovaskuläre Verfahren Thorakotomie 

Resuscitative endovascular balloon occlusion of the aorta

Bridge to surgery

Abstract

Background

Severe hemorrhage remains the leading cause of death among trauma patients. Resuscitative balloon occlusion of the aorta (REBOA) is an endovascular alternative to the established emergency room thoracotomy with cross-clamping of the aorta in patients with severe abdominal or pelvic bleeding.

Objective

The article reports on initial experiences with REBOA.

Methods

Based on the literature and own experiences the pathophysiology, indications, contraindications, technical details and first results with REBOA are presented.

Results

The REBOA procedure is indicated in patients with treatment-refractive hemorrhagic shock with severe abdominal or pelvic bleeding. Via a transfemoral approach a balloon catheter is placed in the aorta and inflated. Depending on the indication the aortic occlusion is located in a supradiaphragmatic (zone 1) or infrarenal (zone 3) position. Experimental results proved a significant increase in central perfusion pressure after performance of REBOA. Furthermore, first clinical data indicate an improved patient survival rate after trauma. Improvements of the devices and minimizing the access trauma using small 7 Fr sheaths decreased the perioperative complication rate.

Conclusion

The REBOA procedure is a promising endovascular technique for temporary stabilization of the circulation in patients with hemorrhagic shock. Further clinical studies and registries have yet to prove its superiority over emergency room thoracotomy.

Keywords

Bleeding Shock Trauma Endovascular procedures Thoracotomy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

K. Elias und M. Engelhardt geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Gefäß- und ThoraxchirurgieAmmerland-KlinikWesterstedeDeutschland
  2. 2.Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Zentrum für Gefäßmedizin der BundeswehrBundeswehrkrankenhaus UlmUlmDeutschland

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